权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Models of Primary Osteoporosis Screening in Male Veterans

男性退伍军人原发性骨质疏松症筛查模型

基本信息

批准号：
9988258
负责人：
CATHLEEN S COLON-EMERIC
金额：
--
依托单位：
DURHAM VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9988258
关键词：
Address Adherence Age Behavioral Caring Chronic Disease Clinic Clinical Collection Data Diagnosis Electronic Health Record Fracture Guidelines Health Policy Health Services Health system Individual Intervention Learning Masks Measures Metabolic Bone Diseases Methods Modeling Morbidity - disease rate Osteoporosis Outcome Patient Selection Patients Performance Pharmaceutical Preparations Policies Policy Maker Population Research Practice Management Prevention Primary Health Care Process Provider Publishing Quality of life Quality-Adjusted Life Years Randomized Regimen Research Personnel Research Priority Resources Risk Risk Factors Roentgen Rays Safety Selection for Treatments Service delivery model Source Specific qualifier value Structural Models System Techniques Testing Time Veterans Veterans Health Administration Work adherence rate aged base bone bone health care costs cohort cost cost effectiveness design disability evidence base fracture risk group intervention health care quality health care service utilization health information technology high risk improved innovation male markov model medication compliance meetings men mortality older men osteoporosis with pathological fracture pain reduction premature prevent program costs programs randomized trial relative cost relative effectiveness satisfaction screening screening guidelines screening program screening services time use tool treatment adherence treatment as usual wasting

项目摘要

Current VA Undersecretary Guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, our recent work in a national Veterans Health Administration cohort of over 4,000,000 men demonstrated that primary osteoporosis screening as it is currently operationalized does not benefit most older Veterans due to inefficient targeting and low subsequent treatment and adherence rates. The overall objective of this application is to determine whether 2 new models of primary osteoporosis screening reduce fracture risk factors in older male Veterans compared to usual care. We propose a group randomized trial of PACTs to: 1) usual care; 2) a PACT practice management model with tools and processes to facilitate screening and adherence activities by PACT providers; 3) a Bone Health Service (BHS) screening model in which screening and adherence activities are managed by a centralized expert team. Both new models include a robust adherence component utilizing evidence-based methods appropriate for the model structure. The specific aims are to: 1) compare the impact of these 2 new screening models vs. usual care on patient-level outcomes strongly associated with fracture rates (eligible proportion screened, proportion meeting treatment criteria who receive osteoporosis medications, and medication adherence); 2) determine the impact of the 2 new screening models on provider and facility-level outcomes including change in DXA volume, change in metabolic bone disease clinic volume, and PACT provider time and satisfaction; and 3) determine the impact of the 2 new screening models on health system and policy outcomes (Markov models of screening program cost per quality adjusted life year based on VA national fracture data, results from aims 1 and 2, and published quality of life estimates). We propose a pragmatic group randomized trial of male Veterans aged 65-85 years meeting current VA Undersecretary primary osteoporosis screening guidelines. PACT teams will be randomized into 3 intervention groups: usual care (control); a PACT practice management model; or a centralized Bone Health Service (BHS) model. Outcomes for all eligible patients within randomized PACTs will be assessed by investigators masked to group assignment via EMR at baseline and 2 years. Analyses will account for 3-levels of clustering and relevant covariates. Expected results are the relative effectiveness and cost-effectiveness of 2 new models of osteoporosis screening and adherence promotion. Next steps include dissemination of the preferred model to a wider array of facilities via centralization of screening services (BHS) or Learning Collaborative with new performance metrics and toolkits (PACT practice management). To our knowledge this would be the first randomized trial of osteoporosis screening in older men. This application directly addresses HSR&D High Priority Research topics including improving medication and behavioral management for chronic disease; improving safety/value; system approaches to promoting high- value care; and innovative use of health information technology to improve diagnosis, reduce low-value care, and increase health care quality and value. The new models proposed in this application test fundamentally different screening paradigms (an individual practice management approach vs. a centralized health system approach) and are designed to be clinically feasible for rapid dissemination across VHA if found to be effective.

目前的退伍军人事务部副部长指南建议对高危男性进行骨质疏松症筛查