Manitoba Health, Winnipeg, Manitoba, Canada.
J Clin Densitom. 2011 Oct-Dec;14(4):422-7. doi: 10.1016/j.jocd.2011.04.008. Epub 2011 Jul 1.
Postfracture care is suboptimal, and strategies to address this major care gap are urgently required. Case management is effective but is resource intensive and difficult to deliver to a widely scattered population. We describe the design and successful implementation of a randomized controlled trial (NCT00594789), which uses provincial administrative health databases to notify eligible physicians and patients after a major osteoporotic fracture that such fractures warrant additional assessment or pharmacologic treatment to prevent subsequent fractures. Men and women aged 50 yr or older residing in the Province of Manitoba, Canada, with a recently reported clinical fracture (hip, spine, humerus, and forearm) from medical claims data, and without recent bone mineral density (BMD) testing (in the last 3 yr) or osteoporosis therapy (in the last year), were randomized to 3 groups: group 1 received usual care, group 2 (physicians only) had mailed notification to the primary care physicians (alert letter, BMD requisition, and management flowchart), and group 3 (physicians and patient) had both physician notifications and patient notification (alert letter). During the initial 10 mo (from June 2008 to March 2009), 2901 fracture patients meeting the inclusion criteria were randomized. Groups were well balanced. Direct costs related to the initiative (programming, case identification, and mailings) were Canadian dollars (CAD$)12,379 during the pilot phase, which translates to CAD$6.50 per notification (groups 2 and 3). Ongoing costs (which exclude the initial programming costs) are estimated at CAD$1.25 per notification. This postfracture intervention, based on medical claims data, provides an easy way to enhance postfracture care. The approach is scalable, can be delivered to a widely scattered population, and requires minimal infrastructure. This low-cost intervention may complement more resource-intensive programs based on case managers.
骨折后护理不尽如人意，迫切需要采取策略来解决这一主要护理差距。病例管理是有效的，但资源密集且难以广泛分散的人群。我们描述了一项随机对照试验（NCT00594789）的设计和成功实施，该试验利用省级行政健康数据库，在主要骨质疏松性骨折后通知合格的医生和患者，此类骨折需要进一步评估或药物治疗，以预防后续骨折。年龄在 50 岁或以上的男女，居住在加拿大马尼托巴省，从医疗索赔数据中报告了最近的临床骨折（髋部、脊柱、肱骨和前臂），并且最近没有进行骨密度（BMD）检测（在过去 3 年中）或骨质疏松症治疗（在过去一年中），随机分为 3 组：组 1 接受常规护理，组 2（仅医生）收到了向初级保健医生的邮寄通知（警示信、BMD 申请和管理流程图），组 3（医生和患者）同时收到了医生和患者的通知（警示信）。在最初的 10 个月（从 2008 年 6 月至 2009 年 3 月）期间，有 2901 名符合纳入标准的骨折患者被随机分组。各组平衡良好。试点阶段与该计划相关的直接成本（编程、病例识别和邮件）为 12379 加元（CAD$），每个通知的费用为 6.50 加元（组 2 和 3）。正在进行的成本（不包括初始编程成本）估计为每个通知 1.25 加元。这种基于医疗索赔数据的骨折后干预措施为加强骨折后护理提供了一种简便方法。该方法可扩展，可用于广泛分散的人群，且基础设施要求低。这种低成本干预措施可能是基于病例经理的更具资源密集型计划的补充。
