title: A randomized trial of a mailed intervention and self-scheduling to improve osteoporosis screening in postmenopausal women.
abstract: Guidelines recommend bone density screening with dual-energy X-ray absorptiometry (DXA) in women 65 years or older, but <30% of eligible women undergo DXA testing. There is a need to identify a systematic, effective, and generalizable way to improve osteoporosis screening. A group randomized, controlled trial of women ≥65 years old with no DXA in the past 4 years, randomized to receive intervention materials (patient osteoporosis brochure and a letter explaining how to self-schedule a DXA scan) versus usual care (control) was undertaken. Outcome of interest was DXA completion. Of 2997 women meeting inclusion criteria, 977 were randomized to the intervention group. A total of 17.3% of women in the intervention group completed a DXA, compared to 5.2% in the control group (12.1% difference, p < 0.0001). When including only those medically appropriate, we found a difference of 19% between the two groups (p < 0.0001). DXA receipt was greater in main clinic patients compared to satellite clinic patients (20.9% main clinic versus 10.1% satellite clinic). The cost to print and mail the intervention was $0.79 per patient, per mailing. The number of women to whom intervention needed to be mailed to yield one extra DXA performed was 9, at a cost of $7.11. DXA scan completion was significantly improved through use of a mailed osteoporosis brochure and the availability for patients to self-schedule. This simple approach may be an effective component of a multifaceted quality improvement program to increase rates of osteoporosis screening.
authors: Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors: Amy H
authors: AH
authors: Warriner
authors: Ryan C
authors: RC
authors: Outman
authors: Elizabeth
authors: E
authors: Kitchin
authors: Lang
authors: L
authors: Chen
authors: Sarah
authors: S
authors: Morgan
authors: Kenneth G
authors: KG
authors: Saag
authors: Jeffrey R
authors: JR
authors: Curtis
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D001071:Appointments and Schedules; D005260:Female; D006801:Humans; D008403:Mass Screening; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging*; D010353:Patient Education as Topic / Q000379:methods*; D011177:Postal Service