Sat., 10/20/07 Geriatrics/Injury Prevention, Paper #46, 9:00 am OTA-2007
A Wake-Up Call to Orthopaedists: Results of the AOA Own the Bone Initiative for Fragility Fractures
Kenneth J. Koval, MD1 (n); Laura Tosi, MD2 (n); Marc Swiontkowski, MD3 (n);
1Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA;
2National Childrens Medical Center, Washington, DC, USA;
3University of Minnesota, Minneapolis, Minnesota, USA
Purpose: The American Orthopaedic Association (AOA)’s Own the Bone initiative was designed to (1) determine the current practice patterns in the management of patients who sustained a fragility fracture and (2) test a program to improve utilization of evidence-based management in the care of fragility fracture patients.
Methods: A series of quality measures were developed based on current guidelines for the prevention, diagnosis, and treatment of osteoporosis. A data set was constructed based on these measures and provided via a Web-based quality improvement registry. Components of this system included an online tool kit with a downloadable library of patient education materials, customizable letter templates to facilitate communication with the patient and the primary care provider, individualized reminders for each patient, and confidential benchmarking reports. The study involved a retrospective chart review of 20 patients at each site who were treated prior to the Own the Bone initiative, followed by a prospective entry of 20 or more patients per site after it started. The effectiveness of the educational intervention was assessed by use of the Fisher exact test
Results: 13 hospital-based facilities and 1 ambulatory-based facility participated. A total of 626 patients were enrolled in the study; 375 were enrolled prior to the start of the Own the Bone intervention and 251 were enrolled in the postintervention analysis. There were no significant differences in demographic or fracture characteristics between the pre- and postintervention groups. Complete data were collected on 87.5% of the 626 patients enrolled.
After initiation of the intervention, statistically significant improvements were made in patient counseling with regard to calcium and vitamin D supplementation, exercise, fall prevention, smoking cessation; and communication with the primary care provider and patient. Calcium and vitamin D supplementation counseling increased from 42% to 88% (P <0.0001) and fall prevention counseling increased from 42% to 90% (P <0.0001). Rates for counseling for smoking cessation nearly doubled, from 48% to 90% (P ≤0.0008). Communication with the primary care physician improved from 31% to 79%, and communication with the patient improved from 38% to 80% (P <0.0001). Sites attributed their improvements in these areas to increased awareness of treatment guidelines, process refinement, and improved organizational skills.
Conclusion and Significance: The preintervention data confirm the work of numerous previous authors—namely, that most orthopedic surgeons are “fixing the fracture,” but not initiating measures to reduce the risk of future fracture. The Own the Bone initiative confronted the problem directly and successfully. Effective January 1, 2007, the Centers for Medicare & Medicaid Services updated their physician voluntary reporting program to include six measures on the impact on osteoporosis or fragility fracture care. Despite recent data that suggest that “pay-for-performance” initiatives only achieve modest improvement in quality, there is no question that it is here to stay. The Own the Bone initiative offers our profession the opportunity to build a coordinated approach to an urgent and costly public health problem.
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