Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan
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Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care.
We evaluated variations in osteoporosis treatment by age, sex, and race/ethnicity by (1) measuring the rates of patients after a fragility fracture who had been evaluated by dual-energy xray absorptiometry and/or in whom antiosteoporosis treatment had been initiated and (2) determining the rates of osteoporosis treatment in patients who subsequently had a hip fracture.
Patients and Methods
We implemented an integrated osteoporosis prevention program in a large health plan. Continuous screening of electronic medical records identified patients who met the criteria for screening for osteoporosis, were diagnosed with osteoporosis, or sustained a fragility fracture. At-risk patients were referred to care managers and providers to complete practice guidelines to close care gaps. Race/ethnicity was self-reported. Treatment rates after fragility fracture or osteoporosis treatment failures with later hip fracture were calculated. Data for the years 2008 to 2009 were stratified by age, sex, and race/ethnicity.
Women (92.1%) were treated more often than men (75.2%) after index fragility fracture. The treatment rate after fragility fracture was similar among race/ethnic groups in either sex (women 87.4%–93.4% and men 69.3%–76.7%). Osteoporotic treatment before hip fracture was more likely in white men and women and Hispanic men than other race/ethnic and gender groups.
Racial variation in osteoporosis care after fragility fracture in race/ethnic groups in this healthcare system was low when using the electronic medical record identifying care gaps, with continued reminders to osteoporosis disease management care managers and providers until those care gaps were closed.
The authors thank Ramon Jimenez, MD, and Alberto Bolanos, MD, of the American Association of Latino Orthopaedic Surgeons for their support of our presentation at the 2010 AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium and Augusto Focil, MD, of the California Hispanic Osteoporosis Foundation for his support of this work. Of course, this work was shepherded into the 2010 Musculoskeletal Healthcare Disparities Research Symposium via the advocacy of Laura Tosi, MD, and Mary O’Connor, MD, who are role models for the next generation of orthopaedic surgeons.
- 8.Institute of Medicine. Race, ethnicity, and language data: standardization for health care quality improvement. Washington, DC: National Academies Press; 2009. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2009/RaceEthnicityData/Race%20Ethnicity%20report%20brief%20FINAL%20for%20web.pdf. Accessed February 23, 2011.