title: Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial.
abstract: CONCLUSIONS
  We conducted a cluster randomized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care. The trial did not find a significant difference in medication use in the intervention arm.
  
  
  BACKGROUND
  This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures.
  
  
  METHODS
  We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide home health agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications. A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre-post design.
  
  
  RESULTS
  There were 11 offices randomized to each of the treatment and control arms; these offices treated 337 and 330 eligible patients, respectively. Among the offices in the intervention arm, the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 %, compared with 15.7 % in the usual care arm (difference in proportions 3.4 %, 95 % CI, -2.6 to 9.5 %). The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward, a nonsignificant difference.
  
  
  CONCLUSIONS
  The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients.
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham (UAB), 1665 University Blvd, RPHB 330, Birmingham, AL, USA, mkilgore@uab.edu.
authors.forename: M L
authors.initials: ML
authors.lastname: Kilgore
authors.forename: R
authors.initials: R
authors.lastname: Outman
authors.forename: J L
authors.initials: JL
authors.lastname: Locher
authors.forename: J J
authors.initials: JJ
authors.lastname: Allison
authors.forename: A
authors.initials: A
authors.lastname: Mudano
authors.forename: B
authors.initials: B
authors.lastname: Kitchin
authors.forename: K G
authors.initials: KG
authors.lastname: Saag
authors.forename: J R
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000407:Alabama; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D004363:Drug Utilization / Q000706:statistics & numerical data; D057286:Electronic Health Records; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D058996:Quality Improvement / Q000458:organization & administration*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents
references.citation: J Fam Pract. 1994 Feb;38(2):166-71
references.pmid: 8308509
references.citation: J Bone Miner Res. 2009 Dec;24(12):2050-5
references.pmid: 19453260
references.citation: South Med J. 2009 Apr;102(4):397-404
references.pmid: 19279529
references.citation: J Am Med Dir Assoc. 2010 Oct;11(8):584-91
references.pmid: 20889095
references.citation: J Gerontol A Biol Sci Med Sci. 2010 Sep;65(9):1012-20
references.pmid: 20530242
references.citation: Arthritis Rheum. 2006 Dec 15;55(6):971-5
references.pmid: 17139645
references.citation: Osteoporos Int. 2011 Jul;22(7):2083-98
references.pmid: 21607809
references.citation: J Cancer Surviv. 2009 Mar;3(1):12-20
references.pmid: 19224371
references.citation: Osteoporos Int. 2011 Aug;22 Suppl 3:465-9
references.pmid: 21847767
references.citation: N Engl J Med. 2007 Nov 1;357(18):1799-809
references.pmid: 17878149
references.citation: Osteoporos Int. 2011 Aug;22 Suppl 3:495-500
references.pmid: 21847772
references.citation: Contemp Clin Trials. 2012 Jan;33(1):206-12
references.pmid: 22005175
references.citation: Osteoporos Int. 2011 Aug;22 Suppl 3:487-94
references.pmid: 21847771
references.citation: J Bone Miner Res. 2007 Mar;22(3):465-75
references.pmid: 17144789