Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture.
Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture.
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DOI：
10.1111/j.1532-5415.2010.02769.x
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发表时间：
2010-04
影响因子：
6.3
通讯作者：
Lee SJ
中科院分区：
文献类型：
--
作者：
Jennings LA;Auerbach AD;Maselli J;Pekow PS;Lindenauer PK;Lee SJ
尽管结合钙、维生素 D (Cal+D) 和抗骨吸收药物或骨形成药物治疗骨质疏松症可以显着降低骨折风险，但髋部骨折后的治疗率仍然很低。院内开始使用推荐药物可改善心脏病的预后；因髋部骨折住院可能代表着类似的改善机会。我们的目的是调查因髋部骨折住院的患者接受 1) Cal+D 和 2) 抗骨吸收或成骨药物的住院治疗率。我们利用 Perspective（一个为衡量质量和医疗保健利用率而开发的数据库）的药房和出院记录，对 2003 年 10 月至 2005 年 9 月期间在 318 家医院因骨质疏松性髋部骨折住院的 51,346 名 65 岁以上患者的院内骨质疏松治疗情况进行了检查。我们的主要结果指标是院内服用 1) Cal+D 和 2) 抗吸收或骨形成药物。 3,405 名患者 (6.6%) 在股骨骨折矫正手术后的任何时间接受了 Cal+D。 3,763 名患者 (7.3%) 接受了抗骨吸收或骨形成药物治疗。只有 1023 名患者 (2%) 接受了理想治疗，接受 Cal+D 和抗骨吸收或骨形成药物。几乎所有患者、提供者和医院层面的治疗率仍然很低。 Cal+D 治疗的最强预测因素是接受抗吸收药物或骨形成药物（调整后 OR=5.50，95% CI：4.84–6.25）；然而，只有 27% 接受这些药物治疗的患者还接受了 Cal+D。髋部骨折患者在院内开始骨质疏松症治疗的比率非常低，这可能是改善护理的一个机会。
Although osteoporosis treatment with a combination of calcium, vitamin D (Cal+D) and an antiresorptive or bone-forming drug can dramatically reduce fracture risk, rates of treatment following hip fracture remain low. In-hospital initiation of recommended medications has improved outcomes in heart disease; hospitalization for hip fracture may represent a similar opportunity for improvement. Our objective was to examine rates of in-hospital treatment with 1) Cal+D and 2) antiresorptive or bone-forming medications in patients hospitalized for hip fractures. Using pharmacy and discharge records from Perspective, a database developed to measure quality and health care utilization, we examined in-hospital osteoporosis treatment in 51,346 patients over age 65 hospitalized for osteoporotic hip fracture at 318 hospitals between October 2003 and September 2005. Our main outcome measures were the in-hospital administration of 1) Cal+D and 2) antiresorptive or bone-forming medications. 3,405 patients (6.6%) received Cal+D anytime after a procedure to correct femoral fracture. 3,763 patients (7.3%) received antiresorptive or bone-forming medications. Only 1023 patients (2%) were prescribed ideal therapy, receiving Cal+D and an antiresorptive or bone-forming medication. Treatment rates remained low across virtually all patient, provider, and hospital level characteristics. The strongest predictor of treatment with Cal+D was the receipt of an antiresorptive or bone-forming medication (Adjusted OR=5.50, 95% CI: 4.84–6.25); however, only 27% of patients who received these medications also received Cal+D. Rates of in-hospital initiation of osteoporosis treatment for hip fracture patients are very low and may represent an opportunity to improve care.
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影响因子：
158.5
作者：
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通讯作者：
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DOI：
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