Bone mineral density (BMD) is one of the strongest predictors of fracture and is the gold standard fordiagnosing osteoporosis. Despite widely promulgated national guidelines, <25% of eligible women receiveBMD testing. Based on very low rates of diagnosis/treatment even among those at greatest fracture risk,few areas of medicine are as well suited for rigorous evidence implementation research as osteoporosis. Thepurpose of this study is to test the incremental impact of simple, generalizable interventions to improveosteoporosis healthcare among women 65+ at high risk. Building on the substantial outcomes researchexperience of our UAB team, we have designed an innovative, highly feasible, implementation researchproject in partnership with 2 Kaiser Permanente (KP) research centers.
The Specific Aims (SA) are:1) To develop and pilot test a multimodal intervention to improve osteoporosis testing/treatment with System(practice redesign with direct patient access BMD test scheduling), Patient (tailored intervention to improvepatient-provider communication and 'close the loop' between knowledge communication and action) andProvider (web-based osteoporosis intervention) components; 2) In over 18,000 patients seen by 330physicians in 25 KP facilities, to conduct a group-randomized trial involving these 3 interventions targetingwomen not previously tested or treated for osteoporosis; 3) To determine the differential impact of the 3interventions in combination with one another. Twelve months following the intervention delivery, we will testhypotheses examining outcomes of BMD testing, prescription/non-prescription osteoporosis treatment,patient-provider communication, and fractures. We will have excellent power to detect even small treatmenteffects for our main hypotheses (absolute change < 5%). Our innovative approach is urgently needed todiscover effective ways to bridge the gap between osteoporosis evidence and clinical practice, is directlyapplicable to the newly formulated Medicare guidelines for osteoporosis quality of care, and has highapplicability to evidence implementation in other musculoskeletal disorders and to other health care settings.
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