Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Osteoporos Int. 2011 Aug;22 Suppl 3:477-82. doi: 10.1007/s00198-011-1704-0. Epub 2011 Aug 17.
The current status of the population's bone health has caused considerable concern in the USA and around the world. In keeping with that situation, the US Surgeon General issued a special report on Bone Health and Osteoporosis in 2004 calling attention to a rapidly increasing healthcare problem especially linked to a growing and aging population base. The report specifically cited the medical profession's failure to treat the underlying osteoporosis in elderly individuals with fragility fractures with a 20% treatment rate as the norm. It was noted that an individual fracture was a sentinel event that provided a "teachable moment" for the patient in order to prevent future fractures. Additional statistics revealed the annual total number of fragility fractures, more than two million, exceeded the combined annual total incidence of stroke, myocardial infarction, and breast cancer. Realizing that the American Heart Association and the cardiology community had a successful US national program encouraging the use of beta blockers in patients after myocardial infarction in order to prevent recurrences, the American Orthopaedic Association (AOA) embarked on a course leading to the development of a program to improve bone healthcare in elderly patients with fragility fractures. The cardiology project, "Get With The Guidelines" (GWTG), included a registry in order to document improvement in cardiac patient care. Therefore, the AOA, a leadership group of orthopaedic surgeons, decided it was time to engage the orthopaedic community in a quality improvement initiative patterned after GWTG. Thus, Own the Bone was created as a multidisciplinary program in order to engage patients and physicians from different specialties who might be involved with the bone health concerns of patients with fragility fractures. After the success of a pilot study from 2005 to 2006, Own the Bone was launched as a US national quality improvement program in 2009. It involves a turnkey protocol, utilizing a web-based registry, in order to complete ten basic measures of patient care in patients 50 years and older with fragility fractures. Those measures center on information and counseling on nutrition, physical activity, lifestyle changes, diagnosis and treatment of osteoporosis, and communication to the patient and primary care physician, mentioning the need for osteoporosis care. While this project was initially meant to be implemented in a hospital setting, it can also be applied in an outpatient clinic or emergency care facility. The program continues to expand to numerous hospitals in many states with the support of a growing number of orthopedists and allied medical specialists interested in bone health and osteoporosis. Thus, Own the Bone is a systems-based, quality improvement initiative which provides many benefits for patients with fragility fractures and their treating physicians.
当前，美国乃至全球都十分关注民众的骨骼健康状况。有鉴于此，美国外科医生于 2004 年发布了一份有关骨骼健康和骨质疏松症的特别报告，提请人们注意一个日益严重的医疗保健问题，尤其是与不断增长和老龄化的人口基数有关的问题。该报告特别指出，医疗专业人员未能以 20%的标准治疗有脆性骨折的老年骨质疏松症患者，这是一个迅速增加的医疗问题。报告指出，个体骨折是一个“预警事件”，为患者提供了一个“可教育时刻”，以防止未来发生骨折。此外，统计数据显示，每年有超过 200 万例脆性骨折的总数超过了中风、心肌梗死和乳腺癌的年度总发病率。美国心脏协会和心脏病学领域意识到，他们在美国有一个成功的国家项目，鼓励在心肌梗死后的患者中使用β受体阻滞剂，以防止再次发作，于是美国骨科协会（AOA）开始制定一个改善老年脆性骨折患者骨骼保健的计划。心脏病项目“遵循指南”（GWTG）包括一个注册系统，以记录改善心脏病人护理的情况。因此，AOA 是一个骨科医生的领导团体，他们决定是时候让骨科社区参与到一个以 GWTG 为模式的质量改进计划中了。因此，Own the Bone 作为一个多学科项目应运而生，旨在让不同专业的患者和医生参与到有脆性骨折患者骨骼健康问题的治疗中。在 2005 年至 2006 年进行了一项试点研究之后，Own the Bone 于 2009 年作为一个美国国家质量改进项目启动。该项目涉及一个交钥匙协议，利用基于网络的注册表，以完成对 50 岁及以上脆性骨折患者的 10 项基本护理措施。这些措施集中在营养、体育活动、生活方式改变、骨质疏松症的诊断和治疗方面的信息和咨询，以及与患者和初级保健医生的沟通，提到骨质疏松症护理的必要性。虽然该项目最初旨在在医院环境中实施，但也可以在门诊诊所或急诊设施中实施。在越来越多对骨骼健康和骨质疏松症感兴趣的骨科医生和相关医学专家的支持下，该项目继续在许多州的许多医院扩展。因此，Own the Bone 是一个基于系统的质量改进计划，为脆性骨折患者及其治疗医生带来了许多好处。
