Osteoporosis is defined by a fragility fracture or hip BMD T score of -2.5 or lower. 1 Osteoporosis is a major health problem that affects 200 million people worldwide and 54 million older adults in the United States. 1,2 Half of all postmenopausal women have an osteoporosis-related fracture during their lifetime, 25% develop a vertebral deformity, and 15% experience a hip fracture. 1
Characteristics of the Guideline SourceThis guideline was developed by the ACP's Clinical Guidelines Committee (Table ), 3 composed of internists who specialize in primary care, health care administration, and medical and health services research. This committee oversees the development and evaluation of evidence-based guidelines published by the ACP. The recommen-dations were based on a systematic review sponsored by the Agency for Healthcare Research and Quality. 4 A conflict of interest disclosure was completed by task force members prior to each meeting. The recommendations were evaluated using the ACP's guideline grading system. 5 The guideline underwent a peer review process through the ACP's journal and was posted online for comments from ACP members and leadership.
Spurred on by recent health care reforms and the Triple Aim’s goals of improving population health outcomes, reducing health care costs, and improving the patient experience of care, emphasis on population health is increasing throughout medicine. Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient’s best interest in every circumstance, which can create ethical tensions for individual physicians and other health care professionals. Because individual medical professionals remain committed primarily to the best interests of individual patients, physicians have a unique role to play in ensuring population health supports this ethical obligation. Using widely recognized principles of medical ethics—nonmaleficence/beneficence, respect for persons, and justice—this article describes the ethical issues that may arise in contemporary population health programs and how to manage them. Attending to these principles will improve the design and implementation of population health programs and help maintain trust in the medical profession.
First the good news. People with genetic, congenital, pediatric-onset traumatic, and acquired disabilities are surviving in record numbers to adulthood (an estimated 86% of Children and Youth with Complex Health Care Needs and Technological Dependencies). 1 Many are the first generation to do so. These include patients typically seen by pediatric rehabilitation doctors including patients with cerebral palsy, spina bifida, and neuromuscular diseases, as well as brain injuries, malignancies, and spinal cord PM R 12 (2020) 602-609 www.pmrjournal.org
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