Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


DXA Screening and Use of Osteoporosis Medications in Two Large Regional Healthcare Systems.

Warriner5,  Amy, Outman4,  Ryan C., Curtis5,  Jeffrey R., Feldstein1,  Adrian, Glauber3,  Harry, Ren2,  Junling, Roblin2,  Douglas

Kaiser Permanente Center for Health Research, Portland, OR
Kaiser Permanente Center for Health Research, Atlanta, GA
Kaiser Permanente Northwest
Univ of Alabama at Birmingham, Birmingham, AL
Univ of Alabama at Birmingham, Birmingham, AL

Statement of Purpose:

To compare the effect of a patient panel-support tool (PST) vs. standard of care on dual energy x-ray absorptiometry (DXA) screening in two large healthcare systems. Despite U.S. guideline recommendations for all women 65 years and older to have a screening bone density scan with central DXA, less than one-third of eligible U.S. women have undergone DXA testing.

Methods:

We evaluated DXA receipt and use of prescription osteoporosis medications among women aged 65–90 in two large healthcare systems. Women were eligible for inclusion in the analysis if they had at least 24 months of enrollment at Kaiser Permanente Georgia (KPGA) or Northwest (KPNW). Primary outcomes included a DXA scan in the past 5 years and use of osteoporosis medications in the past year. The analysis included data obtained in 6 month intervals from January 2005 through July 2009. From this data, we examined the effect of a PST (KPNW) vs. standard of care (KPGA). The PST uses EMR data to graphically display "care gaps" for each patient, based on current evidence. Through this mechanism, primary care physicians within the KPNW system are alerted to order a DXA in patients without a DXA in the previous 5 years (start date February 26, 2007).

Summary of Results:

The number of women undergoing screening DXA increased significantly in the KPNW group with the proportion increasing from 25.3% in January 2005 to 58.7% in July 2009 (Risk Difference {RD} 33.3%, 95% CI 32.5 – 34.1%). This differs from KPGA, in which minimal change in DXA scan use occurred between January 2005 and July 2009, 43.1% and 45.3%, respectively (RD 2.2%, 95% CI 0.6–3.9%). The majority of the increased DXA use was seen following the implementation of the PST, Figure 1.

Figure 1. Percentage of women aged 65–90 receiving DXA screening or prescription of osteoporosis medications in 2005–2009 in KP Northwest and KP Georgia.

However, the number of women taking an osteoporosis medication did not increase significantly over the 5 year period in either region, +3.4% in KPNW and +1.3% in KPGA.

Conclusions:

Among older women, DXA testing increased incrementally over the past 3 years in the KPNW healthcare system, following the implementation of a PST. However, despite the increased screening, the use of osteoporosis-specific medications for fracture risk reduction did not increase significantly. In a similar healthplan that did not implement such a program, the rates of DXA testing remained relatively flat. Further randomized studies are needed to confirm effectiveness of methods to improve appropriate DXA utilization.

To cite this abstract, please use the following information:
Warriner, Amy, Outman, Ryan C., Curtis, Jeffrey R., Feldstein, Adrian, Glauber, Harry, Ren, Junling, et al; DXA Screening and Use of Osteoporosis Medications in Two Large Regional Healthcare Systems. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1543
DOI: 10.1002/art.29309

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