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Electronic Medical Record Reminder Improves Osteoporosis Management After a Fracture: A Randomized, Controlled Trial

Authors

  • Adrianne Feldstein MD, MS,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Patricia J. Elmer PhD, MS,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • David H. Smith RPh, MHA, PhD,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Michael Herson MD,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Eric Orwoll MD,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Chuhe Chen PhD,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Mikel Aickin PhD,

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • Martha C. Swain BA

    1. From the *Center for Health Research, Kaiser Permanente, Portland, OregonNorthwest Permanente, Portland, OregonDepartment of Endocrinology/Bone and Mineral/Osteoporosis, Oregon Health and Science University, Portland, Oregon§Family and Community Medicine, University of Arizona, Tucson, Arizona
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  • This work was presented as an abstract/poster at the 25th annual American Society for Bone and Mineral Research Meeting, September 21, 2003, Minneapolis, Minnesota, and as an abstract/oral presentation at the 10th annual HMO Research Network Conference, May 5, 2004, Detroit, Michigan.

Address correspondence to Adrianne Feldstein, MD, MS, Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227. E-mail: adrianne.c.feldstein@kpchr.org

Abstract

OBJECTIVES: Osteoporosis treatment rates after a fracture are low. This study evaluated methods to increase guideline-recommended osteoporosis care postfracture.

DESIGN: Participants were randomly assigned to usual care or one of two interventions. Analysis of primary outcomes used electronic data and linear regression.

SETTING: A Pacific Northwest nonprofit health maintenance organization.

PARTICIPANTS: Female patients aged 50 to 89 who suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis (n=311) and their primary care providers (n=159).

INTERVENTION: Patient-specific clinical guideline advice to the primary care provider delivered by electronic medical record (EMR) message or electronic reminder to the provider plus an educational letter mailed to the patient.

MEASUREMENTS: BMD measurement and osteoporosis medication.

RESULTS: At 6 months, provider reminder resulted in 51.5% of patients receiving BMD measurement or osteoporosis medication, provider reminder plus patient education resulted in 43.1%, and usual care resulted in 5.9% (P<.001). The effect of provider advice combined with patient education was not significantly different from provider advice alone (P=.88). Patients aged 60 to 69 were 18% (95% confidence interval=3–34) more likely to receive BMD measurement or an osteoporosis medication than those aged 80 to 89.

CONCLUSION: Patient-specific postfracture advice to the provider through an EMR message significantly increased BMD measurement and osteoporosis medication. As EMRs become more widespread, this intervention could improve osteoporosis management for many postfracture patients. Future research should identify barriers to and facilitators of care for older, high-risk patients.

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