A clinician performance initiative to improve quality of care for patients with osteoporosis

Abstract

Background: Osteoporosis is a widespread but largely preventable disease. Improved adherence to screening and treatment recommendations is needed to reduce fracture and mortality rates. Additionally, clinicians face increasing demands to demonstrate proficient quality patient care aligning with evidence-based standards.

Methods: A three-stage, clinician-focused performance improvement (PI) continuing medical education (CME) initiative was developed to enhance clinician awareness and execution of evidence-based standards of osteoporosis care. Clinician performance was evaluated through a retrospective chart analysis of patients at risk or with a diagnosis of osteoporosis.

Results: Seventy-five participants reported their patient practices on a total of 1875 patients before and 1875 patients after completing a PI initiative. Significant gains were made in the use of Fracture Risk Assessment Tool (FRAX) (stage A, 26%, n=1769 vs. stage C, 51%, n=1762; p<0.001), assessment of fall risk (stage A, 46%, n=1276 vs. stage C, 89%, n=1190; p<0.001), calcium levels (stage A, 62%, n=1451 vs. stage C, 89%, n=1443; p<0.001), vitamin D levels (stage A, 79%, n=1438 vs. stage C, 93%, n=1439; p<0.001), and medication adherence (stage A, 88%, n=1136 vs. stage C, 96%, n=1106; p<0.001).

Conclusions: Gains in patient screening, treatment, and adherence were associated with an initiative promoting self-evaluation and goal setting. Clinicians must assess their performance to improve patient care and maintain certification. PI CME is a valid, useful educational tool for accomplishing these standards.

FIG. 1.

Risk assessment for osteoporosis. Future osteoporosis-related risk calculated using bone mineral density (BMD) recorded by central dual x-ray absorptiometry (DXA) (stage A, n=1875, stage C, n=1875, p<0.001) and the Fracture Risk Assessment Tool (FRAX) risk score (stage A, n=1769, stage C, n=1762; p<0.001). *Denotes significant difference between stage A and stage C.

FIG. 2.

Osteoporosis patient screening. Evaluation of secondary osteoporosis (stage A, n=1422, stage C, n=1426; p<0.001) and fall-risk within the past 12 months (stage A, n=1276, stage C, n=1190; p<0.001). *Denotes significant difference between stage A and stage C.