Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.

Journal Article

Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients' medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient's primary provider with specific recommendations for further management. Recommendations were initiated at the provider's discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1%) consults recommended immediate bisphosphonate treatment, and 258 (58.1%) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4%) and by ordering bone density testing in 183 (70.9%) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8% for bisphosphonates and 21.3% for calcium/vitamin D. After implementation, the treatment rate increased to 7.3% for bisphosphonates (p = 0.02) and 35.2% for calcium/vitamin D (p < 0.01). While feasible and relatively low-cost, an E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.

Full Text

Duke Authors

Cited Authors

  • Lee, RH; Lyles, KW; Pearson, M; Barnard, K; Colón-Emeric, C

Published Date

  • June 2014

Published In

Volume / Issue

  • 94 / 6

Start / End Page

  • 659 - 664

PubMed ID

  • 24699797

Electronic International Standard Serial Number (EISSN)

  • 1432-0827

International Standard Serial Number (ISSN)

  • 0171-967X

Digital Object Identifier (DOI)

  • 10.1007/s00223-014-9849-4

Language

  • eng