Background
Within AMGA Foundation’s Osteoporosis Best Practices Learning Collaborative, the following eight motivating needs were identified as barriers to providing quality patient care.
Each participating healthcare organization selected a few motivating needs from the list to focus on for improvement in their organization. Below are some interventions developed by the participating organizations.
Motivating Need 1:
Identifying individuals in a population who are at risk for fracture
Additional DXA machines for better access and increase scheduling availability
Initial DXA screening Best Practice Alert to fire once or every 7 years by default if not acted upon
Integrated DXA screening into the annual wellness visits
Developed an osteoporosis-related fracture screening algorithm and disseminate it to PCPs, gynecology, and endocrine departments with provider education at departmental meetings
Achieve additional referrals to the osteoporosis clinic for appropriate patients as determined by inpatient clinical criteria
Built “Standing Orders” for staff to order referrals to the post-fracture clinic or to directly order a DXA
Motivating Need 2:
Testing and clinical assessment of patients at risk for fracture according to current clinical practice guidelines
Update DXA report format to facilitate accurate diagnosis and interpretation of results.
Motivating Need 3:
Diagnosis and documentation of patients at risk for fracture with appropriate use of testing, fracture risk scores, and clinical assessment
Weekly review of all DXA and X-rays for an abnormal bone DXA (T score < -1.0) or presence of fragility fractures. Developed a new osteoporosis process for abnormal bone DXA
- Implement procedures for documentation of evidence of osteoporosis in patient’s medical record
- Developed osteoporosis pathway
Developed Best Practice Alerts that will re-display every time a patient qualifies for the screening and no DXA was done or a referral in the last 365 days
Motivating Need 4:
Adequate treatment of patients with osteoporosis at risk for fracture
Partnered with EMR analyst to develop embedded treatment suggestions, data capture tools, and automated communications back to the care team to facilitate quality improvement efforts.
Develop Smart Sets in Epic for patients diagnosed with osteoporosis including medication interventions, laboratory tests, and imaging. Developed Best Practice Alert in EPIC for screening patients post-fracture
Motivating Need 5:
Secondary fracture prevention
Create a Best Practice Alert to identify patients with a recent fracture who need a screening DXA
Developed a registry of patients that have gone to the ED with a fracture for outreach.
Motivating Need 6:
Knowledge deficit of prevention and management of patients with osteoporosis
Changed fall risk screening tool requirements from annual to biannual to identify those patients who are at high risk for falls to include the post-fracture patient.
Primary care WebEx on osteoporosis treatment guidelines & osteoporosis screening recommendations added to the internal website.
Motivating Need 7:
Patient awareness and education about osteoporosis
Questionnaire developed and distributed to patients to assess their knowledge of osteoporosis. Patient education material developed from survey responses
Create multi-media (brochures/EMMi video/web links), multi-channel (My Chart messages, AVS updates, patient brochures) patient education campaign
Motivating Need 8:
Care coordination for patients with osteoporosis and fracture
Collaboration between Clinical pharmacist and virtual engagement provider to provide outreach to virtual high-risk patients with prior hip fractures for medication and treatment management to prevent secondary fractures.
Standardize clinical care coordinator outreach to schedule DXA to close care gaps
Work with the IT department to create a form within the EMR to capture DXA/FRAX scores
Survey to understand healthcare providers’ understanding of osteoporosis and provide education.