October 22, 2007
Kaiser Permanente study finds older patients with fractures benefit
from follow-up osteoporosis management program
Kaiser Permanente Database Sets Model for Secondary Osteoporosis Prevention: Outreach Helps Manage Disease That Kills More Older Women Than Breast and Ovarian Cancer Combined
October 22, 2007 (Portland, OR) –Electronic medical records and outreach programs
of e-mail messages, letters and phone calls to patients and their primary care providers
after a bone fracture can dramatically improve the diagnosis and management of the
patients’ osteoporosis, according to a Kaiser Permanente study in the September
issue of the Journal of the American Geriatrics Society. This is the largest study
to show that electronic medical records improve the continuity of care for osteoporosis.
"Often when a patient sustains a fracture, there is a disconnect between the treating
orthopedist and the patient’s primary care physician. With Kaiser
Permanente’s computerized
database and integrated care delivery system, we can closely monitor and follow
patients with fractures and prevent that disconnect,” said Adrianne Feldstein, MD, MS, an investigator at the Kaiser Permanente Center
for Health Research (CHR) in
Portland and the lead author of the study. “This intervention has broad applicability
to a large group of health care providers – from local health departments to HMOs
to PPOs – with access to electronic billing or clinical data. Armed with that data,
these health organizations can make sure their patients with fractures get appropriate
bone density screening follow up.”
This study of 3,588 women shows that an outreach program targeted to patients with
a previous fracture meant there was an improvement from 13.4 percent to 44 percent
of patients being evaluated and/or treated for osteoporosis. Osteoporosis management
is the receipt of a bone mineral density (BMD) measurement or osteoporosis medication
in the six months after a fracture. If widely implemented, this approach could substantially
improve the secondary prevention of osteoporosis, according to the study authors.
Osteoporosis, a bone disease that leads to increased risk of fracture, is a prevalent
condition in older adults, and affects about 20 percent of women 65 and older. Medication
can reduce fracture risk in people with osteoporosis significantly, yet many patients,
even those who already sustained a previous fracture, do not receive the necessary
BMD screening and subsequent treatment. It is estimated that in 2005 there were
2 million fractures at a cost of $17 billion in the United States; by 2025, this
number is expected to increase by 50 percent as the population ages.
“Osteoporosis now causes more deaths annually than breast cancer and ovarian cancer
combined," said Dr. Feldstein “This study shows that we can cost-effectively improve
management with interventions as simple as e-mails, letters and phone calls. That
in turn should reduce fractures and mortality, and improve quality of life.”
Researchers at the Kaiser Permanente Center for Health Research used the organization’s
integrated databases to analyze medical records of 3,588 women aged 67 and older
who sustained qualifying clinical fractures. The women were members of the health
plan in Oregon and had not received a BMD measurement or osteoporosis treatment
in the 12 months before the fracture.
The goal of the study was to evaluate the effect of the interventions on the National
Center for Quality Improvement, Health Employer Data and Information Set (HEDIS)
measure that evaluates the proportion of women age 67 and older who sustained a
qualifying clinical fracture and had not received a BMD measurement or osteoporosis
treatment in the 12 months before the fracture and who received either of these
six months after the fracture.
The study was conducted in two phases: In Phase 1, primary care physicians with
eligible patients were sent an electronic medical record (EMR) in-basket message
that contained patient-specific clinical guideline advice consistent with national
guidelines, as well as offered outreach to the patient. If the PCP elected, patients
were then contacted via an introductory letter and phone call by outreach staff,
who completed a patient record review, counseled the patients regarding risk of
osteoporosis and future fractures, and ordered laboratory testing, medication, or
a BMD measurement. During Phase 2 clinicians and staff were eligible for a financial
incentive for quality improvement based on the osteoporosis HEDIS measure.
“Although the financial incentive helped staff define what the organizational priority
was, being a team player is what drove behavior,” said Dr. Feldstein. “The increase
in performance resulted from re-engineering the patient’s care and ensuring continuity
of care from orthopedist and primary care physician.”
The study was funded in part by a grant from Merck & Co. Inc.
About Kaiser Permanente
Kaiser Permanente is America’s leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente serves the
health care needs of more than 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 156,000 technical, administrative and clerical employees and caregivers, and more than 13, 000 physicians representing all specialties. For more Kaiser Permanente news, visit the KP News Center at:
http://xnet.kp.org/newscenter.
About the Kaiser Permanente Center for Health Research
Kaiser Permanente's
Center for Health Research, founded in 1964, is a nonprofit research institution
dedicated to advancing knowledge to improve health. It has facilities in Portland,
Ore., and Honolulu. Find out more through the center’s website:
http://www.kpchr.org/public/default.aspx.
For more infomation contact:
Terry Fitzpatrick - 503-335-6602, Terry.Fitzpatrick@kpchr.org