Quality health care gaps in osteoporosis: How can patients, providers, and the health system do a better job?

Teng, Gim Gee; Curtis, Jeffrey R.

doi:10.1007/s11914-009-0006-3

Cited by 24 publications

(26 citation statements)

References 55 publications

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“…A number of strategies to improve quality of care in rheumatology have been proposed and tested within the boundaries of traditional care processes, with mixed results [40]. Simple interventions involving educating providers via continuing medical education (CME) generally do not change physician behavior or practice [41].…”

Section: Discussionmentioning

confidence: 99%

The delivery of evidence-based preventive care for older Americans with arthritis

et al. 2010

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IntroductionPrevious research suggests patients with rheumatoid arthritis (RA) may receive suboptimal care with respect to preventive tests and services. We evaluated the proportion of older Americans with RA, psoriatic arthritis (PsA), and osteoarthritis (OA) receiving these services and the specialty of the providers delivering this care.MethodsUsing data from 1999 to 2006 from the Medicare Chronic Conditions Warehouse, we identified persons age >/= 65 in the national 5% sample. Over the required five-year observation period, we identified tests and services recommended for older adults and the associated healthcare provider. Services of interest included dual energy x-ray absorptiometry (DXA), influenza and pneumococcal vaccination, hyperlipidemia lab testing, mammography and colonoscopy.ResultsAfter accounting for the sampling fraction, we identified 141,140 RA, 6,300 PsA, and 770,520 OA patients eligible for analysis. Over five years, a majority of RA, PsA, and OA patients were tested for hyperlipidemia (84%, 89% and 87% respectively) and received DXA (69%, 75%, and 52%). Only approximately one-third of arthritis patients received pneumococcal vaccination; 19% to 22% received influenza vaccination each year. Approximately 20% to 35% of arthritis patients never underwent mammography and colonoscopy over five years. Concomitant care from both a rheumatologist and a primary care physician was significantly associated with a greater likelihood of receiving almost all preventive tests and services.ConclusionsAmong older Americans on Medicare, the absolute proportion of persons with arthritis receiving various recommended preventive services and screening tests was substantially less than 100%. Improved co-management between primary care and arthritis physicians may in part improve the delivery of preventive care for arthritis patients, but novel systematic interventions in this area are needed.

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Section: Discussionmentioning

confidence: 99%

The delivery of evidence-based preventive care for older Americans with arthritis

et al. 2010

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“…1, 2 It represents a major public health problem because of the disability, morbidity, mortality, and cost to which it contributes. Hip fractures are the worst consequences of osteoporosis, as the 1-year mortality of such patients is nearly 30% and it often leads to major morbidity including significant functional loss.…”

Section: Introductionmentioning

confidence: 99%

Use of Osteoporosis Medications after Hospitalization for Hip Fracture: A Cross-national Study

Kim

Sanfélix‐Gimeno³

et al. 2015

The American Journal of Medicine

102

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Purpose While current osteoporosis management guidelines recommend use of pharmacologic treatment following hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study is to quantify the use of and adherence to osteoporosis medication following hip fracture in three countries with different health care systems- the United States, Korea and Spain. Methods In three cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year following the hip fracture. Results We identified 86,202 patients with a hip fracture - 4,704 (U.S. Medicare), 6,700 (U.S. commercial), 57,631(Korea), and 17,167 (Spain). The mean age was 77–83 years and 74–78% were women. In the year prior to the index hip fracture, 16–18% were taking an osteoporosis medication. Within 3 months following the index hip fracture, 11% (U.S. Medicare), 13% (U.S. commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled one or more prescriptions for an osteoporosis medication, the mean PDC in the year following the fracture was 0.70 (U.S. Medicare), 0.67 (U.S. commercial), 0.43 (Korea) and 0.66 (Spain). Conclusions Regardless of differences in health care delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal with the PDC<0.70 in all three countries.

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“…14,15 We applied a patented methodology 16 to assess physicians' clinical performance. We determined performance standards for both competent care, defined as the standard of care patients should expect to receive from all certified physicians, and excellent care, defined as the quality of care patients can expect to receive from a certified physician who has the knowledge and skills needed to deliver recommended care at a higher achievable standard.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Quality of Osteoporosis Care in Practice

Weng

Hess²,

Lynn

et al. 2015

J GEN INTERN MED

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BACKGROUND:Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care. OBJECTIVES: Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care. DESIGN: This was a retrospective cohort study. PARTICIPANTS: Three hundred and eighty one general internists and subspecialists with time-limited board certification were included in the study. MAIN MEASURES: Performance rates on eight evidencebased measures were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module® (PIM), a web-based tool that uses medical chart reviews to help physicians assess and improve care. We applied a patented methodology, using an adaptation of the Angoff standard-setting method and the Dunn-Rankin method, with an expert panel skilled in osteoporosis care to form a composite and establish standards for both competent and excellent care. Physician and practice characteristics, including a practice infrastructure score based on the Physician Practice Connections Readiness Survey (PPC-RS), were used to examine the validity of the inferences made from the composite scores. KEY RESULTS: The mean composite score was 67.54 out of 100 maximum points with a reliability of 0.92. The standard for competent care was 46.87, and for excellent care it was 83.58. Both standards had high classification accuracies (0.95). Sixteen percent of physicians performed below the competent care standard, while 22 % met the excellent care standard. Specialists scored higher than generalists, and better practice infrastructure was associated with higher composite scores, providing some validity evidence. CONCLUSIONS: We developed a rigorous methodology for assessing physicians' osteoporosis care. Clinical performance feedback relative to absolute standards of care provides physicians with a meaningful approach to selfevaluation to improve patient care.

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Quality health care gaps in osteoporosis: How can patients, providers, and the health system do a better job?

Cited by 24 publications

References 55 publications

The delivery of evidence-based preventive care for older Americans with arthritis

The delivery of evidence-based preventive care for older Americans with arthritis

Use of Osteoporosis Medications after Hospitalization for Hip Fracture: A Cross-national Study

Assessing the Quality of Osteoporosis Care in Practice

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