Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

Abstract

Background 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. Questions/purposes 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 MethodsWe 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 selfreported. 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. Results 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. Conclusions 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 Role of Fracture Liaison Services in Re-Fracture Prevention

“…Four studies (9%) included females only. Many studies confirm the well-known gender disparity in the evaluation and treatment of osteoporosis [Bogoch et al, 2006;Cuddihy et al, 2004;Dell et al 2008;Diamond and Lindenberg 2002;Kuo et al, 2007;Navarro et al, 2011].…”

“…The Role of Fracture Liaison Services in Re-Fracture Prevention 283 Lih et al, 2011), US (three studies - Edwards et al, 2005;Dell et al, 2008;Navarro et al, 2011), Canada (three studies - Bogoch et al, 2006;Majumdar et al, 2007Morrish et al, 2009) and Europe (two studies - Clunie et al, 2008;Boudou et al, 2011). A further two studies focused on the cost analysis of individual FLS (Sander et al, 2008;Cooper et al, 2011).…”

“…All except one study [Boudou et al, 2011] evaluated male and female patients, with information on racial background being reported in 3 out of 11 studies [Majumdar et al, 2007Navarro et al, 2011]. The number of patients ranged from 46 to 620,000, but most studies included between 200 to 400 subjects.…”

“…Furthermore, after institution of the Healthy Bones Program, the Kaiser Permanente group reported a significant gender disparity, with a higher treatment rate amongst women (92.1%) compared to men (75.2%) [Navarro et al 2011]. In the same study, amongst those who sustained a further hip fracture, 73.5% of women and 30.7% of men were on osteoporosis treatment at the time of the fracture.…”

AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium: Editorial Comment: A Call to Arms: Eliminating Musculoskeletal Healthcare Disparities

“…Our symposium included many important highlights of disparities such as lower functional outcomes in women undergoing TKA as compared to men [6] and higher rates of amputation for dysvascular limbs in African Americans as compared to white Americans [3]. Moreover, even at an institution with a structured, evidence-based program to address disparities in patients with hip fracture, men were treated less than women for bone health [5], raising the question of unconscious bias on the part of the healthcare providers. As you read these manuscripts, it is sobering to acknowledge the current state of disparities in delivering musculoskeletal care to individuals regardless of gender and ethnicity.…”