Diagnosis and Treatment of Osteoporosis Before and After Fracture: A Side-by-Side Analysis of Commercially Insured and Medicare Advantage Osteoporosis Patients
Diagnosis and Treatment of Osteoporosis Before and After Fracture: A Side-by-Side Analysis of Commercially Insured and Medicare Advantage Osteoporosis Patients
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DOI：
10.18553/jmcp.2017.23.4.461
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发表时间：
2017-07-01
影响因子：
2.1
通讯作者：
Harris, Steven T.
中科院分区：
文献类型：
--
作者：
Weaver, Jessica;Sajjan, Shiva;Harris, Steven T.
背景：尽管美国临床指南推荐治疗骨质疏松症，但在骨质疏松性骨折患者中普遍缺乏诊断和治疗。目的：确定不同类型骨折前后骨质疏松的诊断率和治疗率。方法：使用Humana Medicare Advantage Claims(Medicare组)和Optom Insight Clinformatics Data Mart Commercial Claims(商业组)的数据进行回顾性索赔分析。纳入研究的患者声称患有2008年1月至2013年12月之间的合格骨折(指数骨折)，在指数骨折之前和之后连续参加健康计划1年，在指数骨折发生时，Medicare组的年龄>；=65岁或商业组的年龄>；=65岁。脆性骨折和骨质疏松的诊断由ICD-9-CM编码识别。骨质疏松症的治疗包括口服和注射疗法，这些疗法由国家药品代码编号和医疗保健通用程序编码系统代码标识。在指数性骨折之前和之后的一年期间评估诊断率和治疗率。所有分析均按骨折类型(椎骨、髋部、非髋部/非椎体[NHNV]和多发性)进行，并按年龄和性别进行分层。医疗保险组和商业组之间没有进行比较；而是使用McNemar测试来比较每组中骨折前和骨折后的诊断率和治疗率。结果：纳入医疗保险组的患者有45,603人，商业组有54,145人。骨折前，医保组骨质疏松诊断率为12.0%(NHNV)至21.5%(椎体)，商业组为5.3%(NHNV)至12.1%(椎体)。骨折后诊断率显著提高(P<0.05)。
BACKGROUND: Although treatment for osteoporosis is recommended by U.S. clinical guidelines, a lack of diagnosis and treatment is common among patients with osteoporotic fractures.OBJECTIVE: To determine the rates of osteoporosis diagnosis and treatment before and after various types of fractures.METHODS: This was a retrospective claims analysis using data from the Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (Commercial group). Patients included in the study had a claim for a qualifying fracture occurring between January 2008 and December 2013 (the index fracture), were continuously enrolled in the health plan for >= 1 year before and after the index fracture, and were aged >= 65 years in the Medicare group or years in the Commercial group at the time of the index fracture. Fragility fractures and osteoporosis diagnoses were identified from ICD-9-CM codes. Treatment for osteoporosis included oral and injectable therapies identified by National Drug Code numbers and Healthcare Common Procedure Coding System codes. Diagnosis and treatment rates were assessed during the 1-year periods before and after the index fracture. All analyses were conducted by fracture type (vertebral, hip, nonhip/nonvertebral [NHNV], and multiple), with stratification by age and sex. No comparisons were made between the Medicare and Commercial groups; rather, McNemar tests were used to compare prefracture versus postfracture diagnosis and treatment rates within each group.RESULTS: For inclusion in the Medicare group, 45,603 patients were identified, and 54,145 patients were identified for the Commercial group. In the prefracture period, the osteoporosis diagnosis rates ranged from 12.0% (NHNV) to 21.5% (vertebral) in the Medicare group and from 5.3% (NHNV) to 12.1% (vertebral) in the Commercial group. In the postfracture period, diagnosis rates significantly increased (P