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Outcomes of a disease-management program for patients with recent osteoporotic fracture

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Abstract

Introduction

The purpose of this study was to evaluate outcomes of a disease-management program designed to increase rates of bone-mineral-density (BMD) testing and initiation of osteoporosis medication among patients with a recent osteoporotic fracture.

Study design

We identified 744 consecutive patients aged ≥55 years who were seen at either of 2 of 14 Kaiser Permanente medical facilities in Northern California (KPNC) after sustaining a fracture of the hip, spine, wrist, or humerus between April 2003 and May 2004. These patients were invited to participate in a study of the Fragile Fracture Management Program, whose protocol used fracture-risk assessment tools to determine treatment recommendations. Postfracture care of study participants was compared with usual postfracture care received by osteoporotic-fracture patients at 12 other KPNC facilities.

Results

Of the 744 patients who were invited to participate in the study, 293 (39%) agreed to participate, and 169 (23%) completed the evaluation. Of these 169 patients (127 women, 42 men), 65 (51%) of the women and 7 (17%) of the men qualified for drug treatment; of these 72 patients, 6 (86%) of the men and 41 (63%) of the women accepted the offered treatment. At the two study locations, rates of care (BMD testing or prescribing osteoporosis medication) were about twice as high as rates of usual postfracture care observed at 12 other medical centers in KPNC.

Conclusions

Compared with patients who received usual care for osteoporotic fracture, patients participating in a postfracture disease management program had substantially higher rates of medical attention given for osteoporosis; however, the overall yield of the program was low. This low uptake rate was related to factors not previously appreciated: many patients refused participation in the program; a high proportion of younger women—and men of all ages—did not qualify for treatment; and treatment was refused by one in three study-qualified women and by one in seven study-qualified men. Additional efforts are needed to overcome patient barriers to improved osteoporosis evaluation, treatment and participation in postfracture programs.

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Acknowledgements

The research was funded by a grant from Eli Lilly and Company (Indianapolis, Indiana) and from a Kaiser Permanente Northern California Napa-Solano Service Area Innovation Program grant. Kaiser Permanente Pharmacy Analytical Services (PAS) helped in development of the Information Technology system used for this program. Support was received from Merck Health Management (Whitehouse Station, New Jersey) in the early stages of project development. Michael T. Gee, PharmD, primary-care pharmacist, helped with testing and implementation of the Fragile Fracture Care Management Program. Susan Tweet, LPT; Presie V. Clary; Zoevonda Sutton, RN, MSN, PNP; and Cathy H. Chou, MPA, assisted with program development and operations. We thank John Hills, MD, Physician-in-Charge at the Kaiser Permanente Vacaville facility, for his enthusiastic support of this research. We would like to thank Ruth E. Shaber, MD, and the Kaiser Permanente Women’s Health Research Institute for their support in this endeavor. Editorial assistance was provided by the Medical Editing Service of The Permanente Medical Group Physician Education and Development Department.

Author information

Authors and Affiliations

  1. Department of Medicine, Kaiser Permanente Medical Center, 3700 Vaca Valley Parkway, Vacaville, CA, 95688-9430, USA

    M. Che & J. Liang

  2. Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA

    B. Ettinger & A. R. Pressman

  3. Permanente Federation, Oakland, CA, USA

    J. Johnston

Authors
  1. M. Che
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  2. B. Ettinger
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  3. J. Liang
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  4. A. R. Pressman
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  5. J. Johnston
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Corresponding author

Correspondence to M. Che.

Additional information

Related publication: Che M, Ettinger B, Johnson J, Pressman A, Liang J (2005) Fragile Fracture Care Management Program. Permanente J 9(1):13–5. Available from: http://www.xnet.kp.org/permanentejournal/winter05/fragile.html

Appendices

Appendix I

Hospital and outpatient visit records are scanned to identify previous fracture of wrist, hip, humerus, or spine using the following ICD-9 codes:

  • Wrist: 813.4x, 813.5x, 813.8x, 813.9x

  • Hip: 820.xx

  • Humerus: 812.0x, 812.1x

  • Spine: 805.xx

Appendix II

Diagnoses warranting exclusion:

Disease

ICD-9 code

Acromegaly

253.0

Alcoholic cirrhosis/chronic hepatitis

571

Amyloidosis

277.3

Anorexia nervosa/bulimia

307.1/307.5

Any organ transplantation

V42

Celiac disease

579.0

Chronic renal failure treated with dialysis

V56.0/V45.1

Crohn’s disease

555.0, 555.1, 555.2, 555.9

Cushing’s syndrome

255.0/ 255.3

Cystic fibrosis

277.0

Gastric bypass

537.4

Hemochromatosis

275.0

Hyperthyroidisma

242.9

Hypoparathyroidism/hyperparathyroidism

252.0/252.1

Hypophosphatasia

275.3

Leukemia

204–208

Lymphoma

202

Malabsorption

579.3, 579.8, 579.9

Metastatic cancer to bone

198.5

Multiple myeloma

203

Osteogenesis imperfecta

756.51

Osteomalacia

268.2

Paget’s disease

731

Primary-site bone cancer

170

Prolactinoma or hyperprolactinemia

253.1

Ulcerative colitis

556.9

  1. aOnly if care received in previous 12 months

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Che, M., Ettinger, B., Liang, J. et al. Outcomes of a disease-management program for patients with recent osteoporotic fracture. Osteoporos Int 17, 847–854 (2006). https://doi.org/10.1007/s00198-005-0057-y

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  • DOI: https://doi.org/10.1007/s00198-005-0057-y

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