Adoption of osteoporosis screening in older women

描述(申请人提供)：在美国，至少40%的绝经后妇女会遭受骨质疏松性骨折，但目前医生和患者对骨密度筛查以确定高骨折风险患者的做法知之甚少。这项建议描述了一个综合的、有指导的职业发展和研究计划，将使申请者发展成为预防老年患者骨折的独立调查者。这项提议的核心职业发展目标是通过调查骨质疏松症筛查的模式和障碍，获得在大型国家行政数据集中分析筛查模式和调查方法方面的技能。总而言之，在这个奖项结束时，我将获得对国家预防行为模式的复杂分析、衡量风险认知和健康素养的方法以及调查研究的技能。骨质疏松性骨折非常常见，并导致极大的发病率，已有经证实的预防骨折的干预措施，并已发布了倡导筛查的指南。尽管如此，来自其他预防护理的证据表明，骨质疏松症筛查的采用将是缓慢的，并具有意想不到的影响。如果了解目前骨质疏松症的模式和护理障碍，这种采用可以加速。为了加深这种理解，我们的目标是1)开发一种使用联邦医疗保险管理索赔数据来评估骨密度(BMD)测试率的方法；2)根据患者的特征检查BMD的采用情况；3)检查由初级保健医生护理的患者小组中骨密度测试的使用情况；4)确定患者和医生因素对采用BMD的相对贡献；以及5)使用调查方法进一步探索初步分析中发现的年龄和SES等因素的差异。我们将检查1998-2002年三个州女性的医疗保险数据，并与美国医学会的医生信息联系起来，以检查目标1-4。然后，我们将对初级保健患者进行调查，以评估风险认知、健康素养和计算能力以及其他障碍对患者筛查差异的影响。重要的是，我们要确定缺乏骨质疏松症筛查的风险最大的患者，最少使用筛查的提供者，以及患者报告的筛查障碍，以改善未来的骨质疏松症护理。

DESCRIPTION (provided by applicant): At least 40% of postmenopausal women in the United States will suffer an osteoporotic fracture, yet little is known about current physician and patient practices in bone mineral density screening to identify patients at high fracture risk. This proposal describes an integrated, mentored program of career development and research that will lead to the applicant's development into an independent investigator in prevention of fractures in aging patients. The central career development goal of this proposal is to gain skills in both analysis of screening patterns in large national administrative datasets and in survey methodology through an investigation of patterns in and barriers to the adoption of osteoporosis screening. In sum, at the end of this award, I will have gained skills in sophisticated analyses of national patterns in preventive behaviors, methodology for measuring risk perceptions and health literacy, and survey research. Osteoporotic fractures are very common and cause great morbidity, there are proven interventions to prevent fractures, and guidelines advocating screening have been published. Despite this, evidence from other preventive care suggests adoption of osteoporosis screening will be slow and have unexpected influences. This adoption can be accelerated if current patterns in and barriers to care of osteoporosis are understood. To develop this understanding we aim to 1) Develop a methodology for using Medicare administrative claims data to assess rates of bone mineral density (BMD) testing 2) Examine the adoption of BMD with respect to patient characteristics 3) Examine the use of bone density testing among panels of patients cared for by primary care physicians, 4) Determine the relative contribution of patient and physician factors to adoption of BMD, and 5) Use survey methodology to further explore disparities by factors such as age and SES found in the initial analyses. We will examine Medicare data from women in three states in 1998-2002 linked with physician information from the AMA to examine aims 1-4. We then will survey primary care patients to evaluate the effect of risk perceptions, health literacy and numeracy, and other barriers on patient disparities in screening. It is important that we identify patients at greatest risk for lack of osteoporosis screening, the providers who employ it least, and patient reports of barriers to screening to improve future osteoporosis care.