Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service
Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service
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DOI：
10.1007/s00223-014-9849-4
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发表时间：
2014-06-01
影响因子：
4.2
通讯作者：
Colon-Emeric, Cathleen
中科院分区：
文献类型：
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作者：
Lee, Richard H.;Lyles, Kenneth W.;Colon-Emeric, Cathleen
不到24%的退伍军人在骨折后6个月内接受了适当的骨质疏松症评估和/或治疗。在三个退伍军人事务医疗中心实施了电子咨询（E-consult）服务，以便于识别近期骨折患者并为他们提供治疗建议。E-consult服务使用基于ICD 9诊断代码的临床就诊数据，前瞻性地识别出潜在骨化性骨折的患者。合格患者的医疗记录由代谢骨专家审查，并向患者的主要提供者发送电子咨询说明，其中包含进一步管理的具体建议。建议由提供者自行决定。在2011年至2013年期间，电子咨询服务确定了444名符合条件的低创伤骨折患者，这些患者尚未接受治疗。129例（29.1%）咨询建议立即进行双膦酸盐治疗，258例（58.1%）建议进行骨密度评估。主要提供者对74名患者（57. 4%）开双膦酸盐处方和183名患者（70. 9%）订购骨密度测试做出了回应。在设施一级，在实施电子咨询服务之前，骨折后骨质疏松症的治疗率为双膦酸盐4.8%，钙/维生素D 21.3%。实施后，双膦酸盐的治疗率增加到7.3%（p = 0.02），钙/维生素D的治疗率增加到35.2%（p < 0.01）。虽然可行且成本相对较低，但电子咨询服务适度提高了近期骨折患者的骨质疏松症治疗率。这些结果表明，可能需要一个与患者直接互动的计划，以大幅提高治疗率。
Fewer than 24 % of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients' medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient's primary provider with specific recommendations for further management. Recommendations were initiated at the provider's discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1 %) consults recommended immediate bisphosphonate treatment, and 258 (58.1 %) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4 %) and by ordering bone density testing in 183 (70.9 %) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8 % for bisphosphonates and 21.3 % for calcium/vitamin D. After implementation, the treatment rate increased to 7.3 % for bisphosphonates (p = 0.02) and 35.2 % for calcium/vitamin D (p < 0.01). While feasible and relatively low-cost, an E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.