title: The Bone Health Team: A Team-Based Approach to Improving Osteoporosis Care for Primary Care Patients.
abstract: BACKGROUND
  Significant improvements in secondary prevention of osteoporotic fractures have been noted with fracture liaison services. However, similar models for the primary prevention of such fractures have not been reported.
  
  
  OBJECTIVE
  To determine the impact of a Bone Health Team (BHT) on osteoporosis screening and treatment rates in U.S. veterans in primary care practices.
  
  
  METHODS
  Historical cohort study of a primary care-based intervention of a BHT from February 2013 to February 2015.
  
  
  METHODS
  Community-based outpatient clinics of the Salt Lake City Veterans Affairs Health Care System.
  
  
  METHODS
  Men aged 70 years and older and women aged 65 years and older.
  
  
  METHODS
  Enrollment in the BHT.
  
  
  METHODS
  Rates of dual energy x-ray absorptiometry (DXA) completion, chart diagnosis of osteoporosis or osteopenia, completion of vitamin D measurement, and initiation of fracture reducing medication.
  
  
  RESULTS
  Our cohort consisted of 7644 individuals, 975 of whom were exposed to the BHT and 6669 of whom were not. Comparison of patients exposed to the BHT versus non-exposed subjects demonstrated a substantial increase in all outcome measures studied. Hazard ratios (HRs) from multivariable cox proportional hazard models were: measurement of vitamin D, HR = 1.619 ( P < .001); chart diagnosis of osteopenia, HR = 37.00 ( P < .001); chart diagnosis of osteoporosis, HR = 16.38 ( P < .001); osteoporosis medication, HR = 17.03 ( P < .001); and completion of DXA, HR = 139.9 ( P < .001).
  
  
  CONCLUSIONS
  The implementation of a dedicated BHT produced significantly increased rates of intermediate osteoporosis outcome measures in US veterans in primary care practices. Additional research describing medication adherence rates and cost-effectiveness is forthcoming.
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|2 Roseman University of Health Sciences, South Jordan, UT, USA.
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Lawrence
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Marissa P
authors.initials: MP
authors.lastname: Grotzke
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Rosenblum
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Karla L
authors.initials: KL
authors.lastname: Miller
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Junjie
authors.initials: J
authors.lastname: Ma
authors.affiliation: 1 Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.|3 University of Utah, Salt Lake City, UT, USA.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration
keywords: Bone Health Team; bisphosphonate; collaborative care; osteoporosis; screening