Development of an electronic medical record based intervention to improve medical care of osteoporosis
- First Online:
Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age.
Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009.
Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as “compression deformity”, “wedge deformity”, or “vertebral height loss” which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.
KeywordsGap in medical care Physician attitudes Adiographs Information technology Quality improvement Prevention
- 1.US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the Surgeon General. U.S. Department of Health and Human Services, Office of the Surgeon General, RockvilleGoogle Scholar
- 6.Scheff TJ (1984) Decisions in medicine. Being mentally ill: a sociological theory. Aldine, New York, pp 77–89Google Scholar
- 8.Williams AL, Al-Busaidi A, Sparrow PJ, Adams JE, Whitehouse RW. (2009) Under-reporting of osteoporotic vertebral fractures on computed tomography. Eur J Radiol 69(1):179–183Google Scholar
- 9.Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14(5):821–828Google Scholar
- 13.Kotowicz MA, Melton LJ 3rd, Cooper C, Atkinson EJ, O'Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9(5):599–605Google Scholar
- 19.Harrison JP, Palacio C (2006) The role of clinical information systems in health care quality improvement. Health Care Manag (Frederick) 25(3):206–212Google Scholar
- 28.Balas EA, Boren SA, Griffing G. (1998) Computerized management of diabetes: a synthesis of controlled trials. Proc AMIA Symp. 295-9Google Scholar
- 33.Von Korff M, Gruman J, Schaefer J et al (1997) Collaborative management of chronic illness. Ann Intern Med 127:1097–1102Google Scholar
- 34.Hibbard J (2003) Engaging health care consumers to improve the quality of care. Med Care 41(1Suppl):161–170Google Scholar
- 35.Improving chronic illness care. The Chronic Care Model. http://www.improvingchroniccare.org. Accessed May 25, 2006, 2006
- 48.R Development Core Team. R. (2009) A language and environment for statistical computing. In: Team RDC (ed.) R Foundation for Statistical ComputingGoogle Scholar
- 54.Edwards BJ, Bunta AD, Madison LD et al (2005) An osteoporosis and fracture intervention program increases the diagnosis and treatment for osteoporosis for patients with minimal trauma fractures. Jt Comm J Qual Patient Saf 31(5):267–274Google Scholar
- 61.Majumdar SR, Johnson JA, Bellerose D, et al. (2010) Nurse case-manager vs. multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study. Osteoporos Int. Apr 1Google Scholar
- 69.Pantilat SZ, Lindenauer PK, Katz PP, Wachter RM (2001) Primary care physician attitudes regarding communication with hospitalists. Dis Mon 111(9B):15S–20SGoogle Scholar
- 70.ISCD. ISCD and DXA Task force meet with CMS officials regarding DXA cuts. 2007; http://www.iscd.org/sitesearch/searchresults.cfm. Accessed July 7, 2010
- 71.Rigotti NA, Munafo MR, Stead LF. (2007) Interventions for smoking cessation in hospitalized patients. Cochrane Databases Syst Rev. (3):CD001837Google Scholar
- 73.Agulnek AN, O'Leary KJ, Edwards BJ (2009) Acute vertebral fracture. J Hosp Med: An Off Publ Soc Hosp Med 4(7):E20–E24Google Scholar
- 75.Yoon RS, Macaulay W, Torres G et al (2008) Assessment of inpatient fragility fracture education and outpatient follow-up at an urban tertiary care institution. Endocrin Pract: Off J Am College Endocrin Am Assoc Clin Endocrin 14(1):58–68Google Scholar