title: A clinician performance initiative to improve quality of care for patients with osteoporosis.
abstract: BACKGROUND
  Osteoporosis is a widespread but largely preventable disease. Improved adherence to screening and treatment recommendations is needed to reduce fracture and mortality rates. Additionally, clinicians face increasing demands to demonstrate proficient quality patient care aligning with evidence-based standards.
  
  
  METHODS
  A three-stage, clinician-focused performance improvement (PI) continuing medical education (CME) initiative was developed to enhance clinician awareness and execution of evidence-based standards of osteoporosis care. Clinician performance was evaluated through a retrospective chart analysis of patients at risk or with a diagnosis of osteoporosis.
  
  
  RESULTS
  Seventy-five participants reported their patient practices on a total of 1875 patients before and 1875 patients after completing a PI initiative. Significant gains were made in the use of Fracture Risk Assessment Tool (FRAX) (stage A, 26%, n=1769 vs. stage C, 51%, n=1762; p<0.001), assessment of fall risk (stage A, 46%, n=1276 vs. stage C, 89%, n=1190; p<0.001), calcium levels (stage A, 62%, n=1451 vs. stage C, 89%, n=1443; p<0.001), vitamin D levels (stage A, 79%, n=1438 vs. stage C, 93%, n=1439; p<0.001), and medication adherence (stage A, 88%, n=1136 vs. stage C, 96%, n=1106; p<0.001).
  
  
  CONCLUSIONS
  Gains in patient screening, treatment, and adherence were associated with an initiative promoting self-evaluation and goal setting. Clinicians must assess their performance to improve patient care and maintain certification. PI CME is a valid, useful educational tool for accomplishing these standards.
authors.affiliation: 1 Division of Geriatrics, Endocrinology and Metabolism, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
authors.forename: John P
authors.initials: JP
authors.lastname: Bilezikian
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Berry
authors.forename: William A
authors.initials: WA
authors.lastname: Mencia
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Stowell
authors.forename: Rachel Bongiorno
authors.initials: RB
authors.lastname: Karcher
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003153:Community Health Services; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy*; D005791:Patient Care / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires