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. ? ? ? ?
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