A program with a dedicated coordinator improved chart documentation of osteoporosis after fragility fracture
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Post-fracture osteoporosis care is becoming recognized as essential by the orthopaedic community, but programs and systems are needed to ensure that this care is routinely provided. Chart documentation related to OP, which is valuable for continuity of care, increased significantly following establishment of an osteoporosis program with a dedicated coordinator.
Post-fracture osteoporosis (OP) care has been repeatedly reported to be inadequate. Through a coordinator-based program, we addressed OP care for more than 95% of fragility fracture patients (1), but we do not know if documentation by orthopaedic surgeons improved. The literature suggests that chart documentation, though underestimating true care, is an indicator of the salient aspects of a condition. Thus chart documentation could be used to reflect an emerging recognition of OP as an important issue to be addressed in the orthopaedic management of the fragility fracture. The purpose of this study was to evaluate if there was an increased documentation of OP by orthopaedic surgeons before and after introduction of a coordinator-based program where the coordinator was known to address OP in 95% of cases.
Chart audits were conducted to quantify OP documentation for patients treated after program initiation compared with age-, sex-, and fracture type-matched controls who presented prior to program implementation. Documentation rates were compared using χ2 tests. Multivariable logistic regression analyses were performed to identify patient characteristics associated with OP-related documentation.
After program implementation, chart documentation of OP diagnosis (unadjusted OR 2.2, 95% CI 1.1–4.4), of referral for OP follow-up (unadjusted OR 3.1, 95% CI 1.5–6.1), and of initiation of OP management (unadjusted OR 8.2, 95% CI 4.0–16.5) by orthopaedic surgeons was more likely. Being in the post-implementation group was stronger than any patient factors in predicting OP charting.
Physicians working in a clinic with a coordinator-based OP program were more likely to document OP-related care in patients’ medical charts. We believe this in turn reflected increased attention to OP by physicians in the orthopaedic management of fragility fractures.
KeywordsChart documentation Fragility fracture Orthopaedic surgeons Osteoporosis
The Osteoporosis Exemplary Care Program was funded by an unrestricted program grant provided by Merck Frosst Canada and Co. Ms. Ward was supported by the St. Michael’s Hospital Orthopaedics Research Education Fund. Mr. Laughren was supported by a Summer Student Research Scholarship from the Faculty of Medicine at the University of Toronto. Dr. Beaton is supported by a New Investigators Award, from the Canadian Institute of Health Research.
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