Bone Health and Osteoporosis Center, Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan, Suite 630, Chicago, IL 60611, USA.
Osteoporos Int. 2012 Oct;23(10):2489-98. doi: 10.1007/s00198-011-1866-9. Epub 2012 Jan 25.
Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age.
Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009.
Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.
骨质疏松症在骨质疏松性骨折住院治疗期间很少得到关注。基于电子病历的干预措施（骨质疏松症医嘱集）是在医生和患者的共同参与下制定的。从 2008 年 7 月到 2009 年 4 月，钙补充剂的使用呈上升趋势（s=0.058）；然而，抗吸收药物（13%）或 BMD 检测和骨质疏松症治疗的出院医嘱（10%）的使用率仍然很低。
骨质疏松症在骨质疏松性骨折住院治疗期间很少得到关注。研究人群为 50 岁以上的患者。
西北纪念医院是位于芝加哥的一家三级保健学术医院。这项研究于 2007 年 9 月 1 日至 2009 年 6 月 30 日进行。
医生报告称，治疗障碍包括骨质疏松症的非急性性质、认为骨质疏松症应由初级保健医生处理、对复发性骨折的认识较低、以及放射照片上出现“压缩性变形”、“楔形变形”或“椎体高度丢失”等术语，他们认为这些术语并不能明确表明椎体骨折。基于电子病历的干预措施是在医生和患者的共同参与下制定的。在评估期间，对医学楼层中 50 岁以上的 295 例骨折患者进行了分析。平均年龄为 72±11 岁；74%为女性。骨折部位包括髋部 n=78（27%）、椎体 n=87（30%）、下肢 n=61（21%）、上肢 n=43（15%）和骨盆 n=26（9%）。在电子病历实施前后，骨质疏松症的记录并没有增加（p=0.89）。从 2008 年 7 月到 2009 年 4 月，钙补充剂的使用呈上升趋势（p=0.058）；然而，抗吸收药物（13%）或 BMD 检测和骨质疏松症治疗的出院医嘱（10%）的使用率仍然很低。
在没有电子提醒的情况下，利用医生的输入创建电子病历干预措施，可以增加钙的补充，但不能增加脆性骨折住院时骨质疏松症的诊断或治疗。
