title: Practice-based learning can improve osteoporosis care.
abstract: OBJECTIVE
  To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Internal medicine and subspecialty clinics.
  
  
  METHODS
  Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty.
  
  
  METHODS
  Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review.
  
  
  RESULTS
  Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement.
  
  
  CONCLUSIONS
  Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care.
authors.affiliation: Hess Consulting, St-Nicolas, Québec, Canada.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hess
authors.forename: Mary M
authors.initials: MM
authors.lastname: Johnston
authors.forename: William F
authors.initials: WF
authors.lastname: Iobst
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000628:therapy*; D018802:Patient-Centered Care / Q000379:methods*; D010820:Physicians / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D012647:Self-Assessment; D011795:Surveys and Questionnaires
keywords: osteoporosis; practice-based learning and improvement; quality improvement; quality measurement; systems-based practice