Adoption of osteoporosis screening in older women

描述（由申请人提供）：在美国，至少40%的绝经后妇女将遭受骨质疏松性骨折，但对目前医生和患者在骨密度筛查中识别高骨折风险患者的实践知之甚少。该提案描述了职业发展和研究的综合，指导计划，这将导致申请人的发展成为一个独立的研究人员在预防老年患者骨折。该提案的中心职业发展目标是通过调查采用骨质疏松症筛查的模式和障碍，获得分析大型国家行政数据集中的筛查模式和调查方法的技能。总而言之，在这个奖项结束时，我将获得对预防行为的国家模式进行复杂分析的技能，测量风险认知和健康素养的方法，以及调查研究。骨质疏松性骨折是非常常见的，并造成很大的发病率，有证明干预措施，以防止骨折，并已出版的指南，倡导筛查。尽管如此，其他预防保健的证据表明，采用骨质疏松症筛查将是缓慢的，并有意想不到的影响。如果了解骨质疏松症治疗的当前模式和障碍，这种采用可以加速。为了发展这种理解，我们的目标是1）开发一种方法，用于使用医疗保险行政索赔数据来评估骨矿物质密度（BMD）测试的比率2）检查BMD的采用与患者特征有关3）检查由初级保健医生护理的患者小组中骨密度测试的使用，4）确定患者和医生因素对BMD采用的相对贡献，（5）采用调查方法，进一步探讨在初步分析中发现的年龄和社会经济地位等因素的差异。我们将研究1998-2002年三个州妇女的医疗保险数据，并将其与AMA的医生信息联系起来，以研究目标1-4。然后，我们将调查初级保健患者，以评估风险认知，健康素养和计算能力，以及其他障碍对患者在筛查中的差异的影响。重要的是，我们要确定缺乏骨质疏松症筛查的风险最大的患者，最少使用它的提供者，以及患者报告的筛查障碍，以改善未来的骨质疏松症护理。

DESCRIPTION (provided by applicant): At least 40% of postmenopausal women in the United States will suffer an osteoporotic fracture, yet little is known about current physician and patient practices in bone mineral density screening to identify patients at high fracture risk. This proposal describes an integrated, mentored program of career development and research that will lead to the applicant's development into an independent investigator in prevention of fractures in aging patients. The central career development goal of this proposal is to gain skills in both analysis of screening patterns in large national administrative datasets and in survey methodology through an investigation of patterns in and barriers to the adoption of osteoporosis screening. In sum, at the end of this award, I will have gained skills in sophisticated analyses of national patterns in preventive behaviors, methodology for measuring risk perceptions and health literacy, and survey research. Osteoporotic fractures are very common and cause great morbidity, there are proven interventions to prevent fractures, and guidelines advocating screening have been published. Despite this, evidence from other preventive care suggests adoption of osteoporosis screening will be slow and have unexpected influences. This adoption can be accelerated if current patterns in and barriers to care of osteoporosis are understood. To develop this understanding we aim to 1) Develop a methodology for using Medicare administrative claims data to assess rates of bone mineral density (BMD) testing 2) Examine the adoption of BMD with respect to patient characteristics 3) Examine the use of bone density testing among panels of patients cared for by primary care physicians, 4) Determine the relative contribution of patient and physician factors to adoption of BMD, and 5) Use survey methodology to further explore disparities by factors such as age and SES found in the initial analyses. We will examine Medicare data from women in three states in 1998-2002 linked with physician information from the AMA to examine aims 1-4. We then will survey primary care patients to evaluate the effect of risk perceptions, health literacy and numeracy, and other barriers on patient disparities in screening. It is important that we identify patients at greatest risk for lack of osteoporosis screening, the providers who employ it least, and patient reports of barriers to screening to improve future osteoporosis care.