Practice-based learning can improve osteoporosis care

J Am Geriatr Soc. 2013 Oct;61(10):1651-60. doi: 10.1111/jgs.12451.


Objectives: To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis.

Design: Retrospective cohort study.

Setting: Internal medicine and subspecialty clinics.

Participants: Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty.

Measurements: Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review.

Results: Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement.

Conclusion: Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care.

Keywords: osteoporosis; practice-based learning and improvement; quality improvement; quality measurement; systems-based practice.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Clinical Competence*
  • Female
  • Humans
  • Internal Medicine / methods*
  • Male
  • Middle Aged
  • Osteoporosis / therapy*
  • Patient-Centered Care / methods*
  • Physicians / standards*
  • Quality Improvement / organization & administration*
  • Reproducibility of Results
  • Retrospective Studies
  • Self Care / methods*
  • Self-Assessment
  • Surveys and Questionnaires