A Patient Activation Intervention to Enhance Bone Health

增强骨骼健康的患者激活干预措施

• 批准号: 8234965
• 负责人: Peter M Cram
• 金额: $ 158.54万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8234965
• 关键词: 1 year old; Adult; Advisory Committees; Age; Aging; Alcohol consumption; Behavior Therapy; Bone Density; Calcium; Caring; Chronic Disease; Client satisfaction; Clinical; Clinical Practice Guideline; Communication; Cues; Direct Costs; Effectiveness of Interventions; Elderly; Epidemiologic Studies; Exercise; Failure; Fracture; Guidelines; Health Care Costs; Healthcare; Intake; Intervention; Knowledge; Letters; Mails; Measures; Modeling; Modification; Nursing Faculty; Osteopenia; Osteoporosis; Patients; Pharmacotherapy; Population; Prevalence; Preventive; Provider; Quality of Care; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Risk; Risk Factors; Scanning; Screening procedure; Self Care; Services; Site; Subgroup; Supplementation; Surgeon; Telephone; Test Result; Testing; Time; Tobacco Use Cessation; Vitamin D; Weight-Bearing state; Woman; base; behavior change; bone; bone health; bone loss; bone quality; clinically relevant; cost; cost effectiveness; design; economic evaluation; emerging adult; follow-up; health belief; improved; men; novel; patient population; preference; prevent; public health relevance; response; satisfaction; smoking cessation; treatment as usual; young adult

DESCRIPTION (provided by applicant): Bone mineral density (BMD) peaks in early adulthood and declines progressively with aging. As BMD declines from normal, to low (formerly called osteopenia), to osteoporosis, risk of fractures progressively increases. In an effort to prevent bone loss and reduce fracture risk, most widely accepted guidelines including the U.S. Preventive Services Task Force and Surgeon General's Office now recommend BMD screening of older adults using dual energy x-ray absorptiometry (DXA). The rationale for screening is that patients and their providers will use DXA results as a "cue to action" and take necessary steps to enhance bone health through lifestyle modification (e.g., weight bearing exercise), Calcium/Vitamin D supplementation, and pharmacotherapy when indicated. However, multiple studies have demonstrated that patients and providers often fail take recommended actions following DXA testing, thus defeating much of the purpose of screening. Over the past five years we have systematically developed and pilot tested a low-cost and practical patient activation intervention based upon the Health Belief Model. The intervention consists of the DXA scanning center mailing each patient a customized letter containing the results of their DXA scan plus educational information about osteoporosis, supplemented by a follow-up phone call from a nurse educator. Preliminary studies have demonstrated that the intervention is well received by both patients and providers and enhances bone-related quality of care. The overarching objective of the current proposal is to rigorously examine the impact of our patient activation intervention on bone-related quality of care in adults undergoing screening DXA scans through a randomized-controlled trial conducted at three study sites. In addition, we will examine the real-world costs associated with our intervention and the impact of our intervention on the overall cost-effectiveness of BMD screening. We hypothesize that the activation intervention will increase optimization of Calcium/Vitamin D intake, enhance use of pharmacotherapy when indicated, will improve patient satisfaction with their bone-related healthcare, and improve patients' osteoporosis specific knowledge when compared with usual care. PUBLIC HEALTH RELEVANCE: There is growing evidence that patients undergoing bone mineral density testing (BMD) often do not take important steps to improve their bone health. We will conduct a randomized-controlled trial to evaluate the impact of a novel and practical patient activation intervention (mailing patients their bone density test results) on the quality of bone-related healthcare and the cost-effectiveness of BMD testing. Equally important, our intervention could easily be modified to include other patient populations and chronic diseases.

描述（由申请人提供）：骨矿物质密度（BMD）在成年早期达到峰值，并随着年龄的增长而逐渐下降。随着骨密度从正常下降到低（以前称为骨质减少），再到骨质疏松，骨折的风险逐渐增加。为了防止骨质流失和降低骨折风险，包括美国预防服务工作组和外科医生办公室在内的最广泛接受的指南现在建议使用双能 X 射线吸收测定法 (DXA) 对老年人进行 BMD 筛查。筛查的基本原理是，患者及其提供者将使用 DXA 结果作为“行动提示”，并采取必要措施通过生活方式改变（例如负重运动）、钙/维生素 D 补充和药物治疗（如有指征）来增强骨骼健康。然而，多项研究表明，患者和医疗服务提供者常常无法在 DXA 测试后采取建议的行动，从而违背了筛查的大部分目的。在过去的五年中，我们系统地开发并试点了基于健康信念模型的低成本且实用的患者激活干预措施。干预措施包括 DXA 扫描中心向每位患者邮寄一封定制信件，其中包含 DXA 扫描结果以及有关骨质疏松症的教育信息，并辅以护士教育者的后续电话。初步研究表明，该干预措施受到患者和提供者的好评，并提高了与骨骼相关的护理质量。当前提案的总体目标是通过在三个研究中心进行的随机对照试验，严格检查我们的患者激活干预对接受 DXA 扫描筛查的成人的骨骼相关护理质量的影响。此外，我们将研究与我们的干预相关的现实成本以及我们的干预对 BMD 筛查总体成本效益的影响。我们假设，与常规护理相比，激活干预将提高钙/维生素 D 摄入量的优化，在有需要时加强药物治疗的使用，提高患者对骨骼相关医疗保健的满意度，并提高患者对骨质疏松症的具体知识。 公众健康相关性：越来越多的证据表明，接受骨矿物质密度测试 (BMD) 的患者通常不会采取重要措施来改善骨骼健康。我们将进行一项随机对照试验，以评估新颖实用的患者激活干预措施（向患者邮寄骨密度测试结果）对骨相关医疗保健质量和 BMD 测试成本效益的影响。同样重要的是，我们的干预措施可以很容易地进行修改，以包括其他患者群体和慢性疾病。