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BMD从正常下降到低（以前称为骨质减少），再到骨质疏松症，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，通过改变生活方式（例如，负重运动）、钙/维生素D补充和药物治疗（如有指征）。然而，多项研究表明，患者和医疗服务提供者在DXA测试后经常未能采取建议的行动，从而违背了筛查的大部分目的。在过去的五年里，我们系统地开发和试点测试了一个低成本和实用的病人激活干预的基础上的健康信念模型。干预措施包括DXA扫描中心向每位患者邮寄一封定制的信件，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，干预措施受到患者和提供者的欢迎，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筛查扫描的成人骨相关护理质量的影响。此外，我们将研究与我们的干预措施相关的实际成本，以及我们的干预措施对BMD筛查总体成本效益的影响。我们假设，与常规护理相比，激活干预将增加钙/维生素D摄入的优化，在有指征时加强药物治疗的使用，将提高患者对其骨相关医疗保健的满意度，并提高患者对骨质疏松症的特定知识。 公共卫生相关性：越来越多的证据表明，接受骨矿物质密度测试（BMD）的患者通常不会采取重要措施来改善其骨骼健康。我们将进行一项随机对照试验，以评估一种新颖实用的患者激活干预（向患者邮寄骨密度测试结果）对骨相关医疗保健质量和BMD测试成本效益的影响。同样重要的是，我们的干预措施可以很容易地进行修改，以包括其他患者群体和慢性疾病。

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. PUBLIC HEALTH RELEVANCE: There is growing evidence that patients undergoing bone mineral density testing (BMD) often do not take important steps to improve their bone health. We will conduct a randomized-controlled trial to evaluate the impact of a novel and practical patient activation intervention (mailing patients their bone density test results) on the quality of bone-related healthcare and the cost-effectiveness of BMD testing. Equally important, our intervention could easily be modified to include other patient populations and chronic diseases.