Predictors of Osteoporosis Screening Completion Rates in a Primary Care Practice

DeJesus, Ramona S.; Chaudhry, Rajeev; Angstman, Kurt B.; Stephen, S.; Tulledge–Scheitel, Sidna M.; Kesman, Rebecca L.; Bernard, Matthew E.; Stroebel, Robert J.

doi:10.1089/pop.2010.0057

Cited by 11 publications

(11 citation statements)

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“…Professor Hsu rightfully mentioned the impact that certain factors can have on osteoporosis screening. After this paper's publication, we had subsequently reported on predictors of osteoporosis screening completion in our practice using the same population group and covering similar time frames [1]. We found that factors associated with increased likelihood of screening completion included race, marital status, presence of certain co-morbidity (cancer, rheumatologic diseases) and type of clinic visit (general exam visit).…”

Section: To the Editormentioning

confidence: 93%

Use of a clinical decision support system to increase osteoporosis screening

DeJesus

2012

Evaluation Clinical Practice

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Background In 2002, the US Preventive Services Task Force recommended routine osteoporosis screening for women aged 65 years or older. However, studies have indicated that osteoporosis remains underdiagnosed, and various methods such as the use of health information technology have been tried to increase screening rates. We investigated whether we could boost the low rates of bone mineral density testing with implementation of a point-of-care clinical decision support system in our primary care practice. Methods We retrospectively reviewed the medical records of female patients eligible for osteoporosis screening who had no prior bone mineral density test who were seen at our primary care practice sites in 2007 or 2008 (before and after implementation of a pointof-care clinical decision support system). Results Overall, screening rates were 80.1% in 2007 and 84.1% in 2008 (P < 0.001). Of patients who did not have osteoporosis screening before the visit, 5.87% completed the screening after the visit in 2007, compared with 9.79% in 2008 (when the clinical support system was implemented), a 66.7% improvement (P = 0.025). Conclusion Clinical decision support for primary care doctors significantly improved osteoporosis screening rates among eligible women. Carefully designed clinical decision support systems can optimize care delivery, ensuring that important preventive services such as osteoporosis screening for patients at risk for fracture are performed while unnecessary testing is avoided.

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Section: To the Editormentioning

confidence: 93%

Use of a clinical decision support system to increase osteoporosis screening

DeJesus

2012

Evaluation Clinical Practice

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“…A 1997 study showed that patients with chronic illness were less likely to receive recommended preventive services, 3 as did a more recent report focused only on patients with diabetes mellitus. 4 In contrast, other reports have shown positive associations between chronic disease comorbidity and osteoporosis screening, 5 and between rheumatoid arthritis and dyslipidemia and osteoporosis screening. 6 …”

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confidence: 93%

Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations

Ornstein

Jenkins

Litvin

et al. 2013

The Annals of Family Medicine

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PURPOSE Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database derived from electronic health records. METHODSWe conducted a cross-sectional study as of October 1, 2011, of the association between being up to date with 10 preventive services and the prevalence of 24 chronic illnesses among 667,379 active patients aged 18 years or older in 148 member practices in a national PBRN. We used generalized linear mixed models to assess for the association of being up to date with each preventive service as a function of the patient's number of chronic conditions, adjusted for patient age and encounter frequency. RESULTSOf the patients 65.4% had at least 1 of the 24 chronic illnesses. For 9 of the 10 preventive services there were strong associations between the odds of being up to date and the presence of chronic illness, even after adjustment for visit frequency and patient age. Odds ratios increased with the number of chronic conditions for 5 of the preventive services.CONCLUSIONS Rather than a barrier, the presence of chronic illness was positively associated with receipt of recommended preventive services in this large national PBRN. This finding supports the notion that modern primary care practice can effectively deliver preventive services to the growing number of patients with multiple chronic illnesses. Ann Fam Med 2013;344-349. doi:10.1370/afm.1502. INTRODUCTION It has long been argued that competing demands in the primary care encounter are barriers to the effective delivery of clinical preventive services.1 One estimate is that 7.4 hours of a primary care clinician's workday would be needed to provide services recommended by the US Preventive Services Task Force (USPSTF), 2 clearly impossible given competing demands for acute care, chronic care, and other responsibilities.An alternative perspective is that encounters primarily for other reasons, particularly for chronic illnesses that entail frequent clinician contacts, would facilitate delivery of clinical preventive services. Research to date on this issue has yielded inconsistent findings. A 1997 study showed that patients with chronic illness were less likely to receive recommended preventive services, 3 as did a more recent report focused only on patients with diabetes mellitus. 4 In contrast, other reports have shown positive associations between chronic disease comorbidity and osteoporosis screening, 5 and between rheumatoid arthritis and dyslipidemia and osteoporosis screening. CHRONIC IL L NES S A ND PR E V EN T IV E SERV IC ES DEL IV ERYAll existing reports are limited by the number of practices, patients, preventive services, and chronic illnesses analyzed. In this report, we analyze the cross-sectional association between receipt of 10 preventive services recommended by the USPSTF and ...

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“…Increasing rates of BMD screening fills a clinical need as previous studies have demonstrated adherence rates to screening guidelines of 12 to 56% across groups and 19 to 97% among individual physicians [15, 16]. While one might presume providers and patients adhering to screening recommendations for colon cancer and polyps would also adhere to osteoporosis screening guidelines, 32.1% of the patients for whom BMD screening was indicated in this study had not undergone screening.…”

Section: Discussionmentioning

confidence: 76%

Opportunistic Osteoporosis Screening: Addition of Quantitative CT Bone Mineral Density Evaluation to CT Colonography

Ziemlewicz

Binkley

Pickhardt

2015

Journal of the American College of Radiology

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Purpose For patients undergoing CT colonography, an opportunity exists for concurrent osteoporosis screening without additional radiation exposure or patient time using proximal femur quantitative CT (QCT) “CTXA”. Materials and Methods This cohort included 129 female and 112 male adults (mean age, 60.1±8.2 years; range, 50–95 years) who underwent CT colonography between March 2013 and September 2014. Areal BMD in g/cm2 and resultant left femoral neck T-score was prospectively measured on the supine CT series using QCT Pro Version 5.1 (Mindways Software, Austin, TX). QCT results were reported with the CT colonography. Chart review evaluated if the patients were eligible for BMD screening according to the United States Preventative Service Task Force (USPSTF) and National Osteoporosis Foundation (NOF) guidelines, had undergone prior BMD testing, and to assess if QCT results changed patient management. Results Overall, 68.0% (164/241) of patients from this cohort had not previously undergone BMD screening. According to the NOF guidelines, 44.0% (106/241) of patients were eligible for screening. T-scores within the osteopenic and osteoporotic range were detected in 32.3% (78/241) and 5.0% (12/241) of patients respectively. Of these patients with low bone mineral density, 66.7% (60/90) had not previously undergone screening or were eligible for BMD testing. Reporting of CTXA T-scores altered management in 9 patients (3.7%) with low bone mineral density. Conclusion Maximizing the pre-existing value from imaging studies is crucial in the current era of healthcare reform. We demonstrate the ability to combine colorectal and osteoporosis screening at CT, adding clinical and likely economic value.

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Predictors of Osteoporosis Screening Completion Rates in a Primary Care Practice

Cited by 11 publications

References 10 publications

Use of a clinical decision support system to increase osteoporosis screening

Use of a clinical decision support system to increase osteoporosis screening

Preventive Services Delivery in Patients With Chronic Illnesses: Parallel Opportunities Rather Than Competing Obligations

Opportunistic Osteoporosis Screening: Addition of Quantitative CT Bone Mineral Density Evaluation to CT Colonography

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