Improving Care of Osteoporosis: Multi-Modal Interventions to Increase Testing

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Bone mineral density (BMD) is one of the strongest predictors of fracture and is the gold standard for diagnosing osteoporosis. Despite widely promulgated national guidelines, <25% of eligible women receive BMD testing. Based on very low rates of diagnosis/treatment even among those at greatest fracture risk, few areas of medicine are as well suited for rigorous evidence implementation research as osteoporosis. The purpose of this study is to test the incremental impact of simple, generalizable interventions to improve osteoporosis healthcare among women 65+ at high risk. Building on the substantial outcomes research experience of our UAB team, we have designed an innovative, highly feasible, implementation research project in partnership with 2 Kaiser Permanente (KP) research centers. The Specific Aims (SA) are: 1) To develop and pilot test a multimodal intervention to improve osteoporosis testing/treatment with System (practice redesign with direct patient access BMD test scheduling), Patient (tailored intervention to improve patient-provider communication and "close the loop" between knowledge communication and action) and Provider (web-based osteoporosis intervention) components; 2) In over 18,000 patients seen by 330 physicians in 25 KP facilities, to conduct a group-randomized trial involving these 3 interventions targeting women not previously tested or treated for osteoporosis; 3) To determine the differential impact of the 3 interventions in combination with one another. Twelve months following the intervention delivery, we will test hypotheses examining outcomes of BMD testing, prescription/non-prescription osteoporosis treatment, patient-provider communication, and fractures. We will have excellent power to detect even small treatment effects for our main hypotheses (absolute change < 5%). Our innovative approach is urgently needed to discover effective ways to bridge the gap between osteoporosis evidence and clinical practice, is directly applicable to the newly formulated Medicare guidelines for osteoporosis quality of care, and has high applicability to evidence implementation in other musculoskeletal disorders and to other health care settings.