Glucocorticoids are used to treat an estimated 30 million Americans with a variety of serious inflammatory disorders. Glucocorticoid-induced osteoporosis (GIOP) is an endemic musculoskeletal disorder that is currently inadequately prevented or treated by the majority of physicians. We propose a national, group-randomized, controlled trial of 150 single physician practices to test the effect of an innovative Internet- delivered multi-model physician intervention designed to increase recognition prevention and treatment of GIOP.
The specific aims of this study are to: 1) Develop an Internet website serving as the venue for physician education, performance, feedback, and printable materials on GIOP prevention and treatment 2) Develop evidence-based quality measures for the management of GIOP suitable for use in physician-based feedback as a core component of the physician intervention 3) Conduct a randomized trial to ascertain the effectiveness of a multi- modal physician intervention in improving GIOP process of care and patient outcomes. We will test the following hypotheses: 1) Intervention physicians will improve more on GIOP quality measures than control physicians. 2) Glucocorticoid-using patients of intervention physicians will have better health related quality of life (HRQOL) and satisfaction than patients of control physicians. Using claims data from Aetna Inc., we will identify chronic users of glucocorticoids and link these patients with their primary care and specialty physicians. From these physicians, we will then randomly select a pool of physicians to participate in a group-randomized study. We will equally randomize the physicians to an intervention or control arm. The physician-level intervention will include confidential and personal physician feedback on pre-defined quality measures for GIOP. Anonymous peer-based comparison and benchmarks will be provided through an Internet site for physicians containing aq case-based educational program as well as materials promoting system changes (e.g. Internet-based printable chart reminders), and printable materials for patient education. With a research team that has a proven record of collaboration in outcomes research, this project will produce an evidence-based and replicable intervention that can be sustained in the """"""""real world"""""""", and readily adapted into other health care settings. Beyond the very high clinical relevance or our study, our approach using a novel internet-based intervention will be of value in deciding future disease management strategies for many chronic diseases.
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