Development of an electronic medical record based intervention to improve medical care of osteoporosis

B. J. Edwards*, A. D. Bunta, J. Anderson, A. Bobb, A. Hahr, K. J. O'Leary, A. Agulnek, L. Andruszyn, K. A. Cameron, M. May, N. H. Kazmers, N. Dillon, D. W. Baker, M. V. Williams

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Summary: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s00.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. Introduction: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age. Methods: Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009. Results: Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72± 11 years; 74% were female. Sites of fracture included hip n078 (27%), vertebral n087 (30%), lower extremity n061 (21%), upper extremity n043 (15%) and pelvis n026 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p00.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p00.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. Conclusion: An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.

Original languageEnglish (US)
Pages (from-to)2489-2498
Number of pages10
JournalOsteoporosis International
Volume23
Issue number10
DOIs
StatePublished - Oct 1 2012

Keywords

  • Adiographs
  • Gap in medical care
  • Information technology
  • Physician attitudes
  • Prevention
  • Quality improvement

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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