A Patient Activation Intervention to Enhance Bone Health

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，患者和提供者在 DXA 测试后往往无法采取建议的行动，从而违背了筛查的大部分目的。在过去的五年里，我们基于健康信念模型系统地开发并试点了一种低成本且实用的患者激活干预措施。该干预措施包括 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，我们将检查与我们的干预相关的现实成本以及我们的干预对 BMD 筛查整体成本效益的影响。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。

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.