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

骨矿物质密度（BMD）是骨折的最强预测因子之一，也是骨密度的金标准。 诊断骨质疏松症。尽管广泛颁布了国家指导方针，但只有不到25%的符合条件的妇女获得了 BMD测试。基于即使在骨折风险最高的人群中诊断/治疗率也很低， 很少有医学领域像骨质疏松症一样适合严格的证据实施研究。的 这项研究的目的是测试简单的，可推广的干预措施的增量影响，以改善 65岁以上女性骨质疏松症的高风险保健。基于实质性成果研究 我们的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 该项目与2个Kaiser Permanente（KP）研究中心合作。具体目标（SA）是： 1)开发和试点测试多模式干预，以改善系统的骨质疏松症检测/治疗 （通过直接患者访问BMD测试计划进行重新设计），患者（定制干预以改善 患者-提供者沟通和知识沟通与行动之间的“闭环”）， 提供者（基于网络的骨质疏松症干预）组件; 2）在330个国家的18，000多名患者中 25个KP设施的医生，进行一项涉及这3种干预措施的组随机试验， 妇女以前没有测试或治疗骨质疏松症; 3）确定的差异影响的3 相互结合的干预措施。干预交付后的12个月，我们将测试 检查BMD测试、处方/非处方骨质疏松治疗结果的假设， 医患沟通和骨折我们将有很强的能力检测出即使是很小的治疗 我们的主要假设的影响（绝对变化< 5%）。迫切需要我们的创新方法， 发现有效的方法来弥合骨质疏松症证据和临床实践之间的差距， 适用于新制定的骨质疏松症医疗保健指南的护理质量，并具有很高的 适用于其他肌肉骨骼疾病和其他卫生保健环境中的证据实施。

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.