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

骨密度(BMD)是预测骨折的最强指标之一，也是诊断骨折的金标准 诊断骨质疏松症。尽管广泛颁布了国家指南，但25%的符合条件的女性获得了 骨密度检测。即使是在骨折风险最大的人群中，诊断/治疗率也非常低， 很少有医学领域像骨质疏松症那样适合进行严格的证据实施研究。这个 这项研究的目的是测试简单、可推广的干预措施的增量影响，以改善 65岁以上高危女性的骨质疏松症医疗保健。建立在实质性成果研究的基础上 根据我们UAB团队的经验，我们设计了一个创新的、高度可行的实施研究 与两个凯撒永久(KP)研究中心合作的项目。具体目标(SA)包括： 1)开发和试点多模式干预措施，以改善骨质疏松症检测/治疗系统 (使用患者直接访问的BMD测试计划进行重新设计)，患者(量身定制的干预措施以改善 患者与提供者之间的交流以及知识交流和行动之间的“闭合回路”)和 提供者(基于网络的骨质疏松症干预)组件；2)在超过18,000名患者中使用330 在25个KP设施中的医生，进行一项涉及这3种靶向干预措施的分组随机试验 以前没有接受过骨质疏松症测试或治疗的女性；3)确定这3种药物的不同影响 相互结合的干预措施。在干预措施实施12个月后，我们将测试 检验骨密度测试结果的假设，处方/非处方骨质疏松症治疗， 患者与提供者之间的沟通，以及骨折。即使是很小的治疗，我们也会有很强的检测能力 对我们的主要假设的影响(绝对变化&lt；5%)。我们迫切需要创新的方法来 寻找有效的方法弥合骨质疏松症证据和临床实践之间的差距，是直接的 适用于新制定的医保骨质疏松症护理指南，并具有较高的 适用于其他肌肉骨骼疾病的证据实施和其他卫生保健环境。

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.