Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Arch Osteoporos. 2024 Jun 11;19(1):48. doi: 10.1007/s11657-024-01399-y.
This pilot audit explored how bone health is assessed patients with diabetes in diverse centres across Asia. Only 343 of 1092 (31%) audited patients had a bone health assessment, 27% of whom were diagnosed with osteoporosis. Quality improvement strategies are needed to address gaps in patient care in this area.
The Asia Pacific Consortium on Osteoporosis (APCO) Framework outlines clinical standards for assessing and managing osteoporosis. A pilot audit evaluated adherence to clinical standard 4, which states that bone health should be assessed in patients with conditions associated with bone loss and/or increased fracture risk; this report summarises the audit findings in patients with diabetes. A secondary aim was to assess the practicality and real-world use of the APCO bone health audit tool kit.
Eight centres across Asia participated in the pilot audit, selecting diabetes as the target group. Participants reviewed their practice records for at least 20 consecutively treated patients with the target condition. Questions covered routine investigations, bone health assessment, osteoporosis diagnosis, and patient referral pathways. Data were summarised descriptively.
The participants represented public hospitals, university medical centres, and private clinics from India, Malaysia, Pakistan, Singapore, Taiwan, and Vietnam that see an estimated total of 95,000 patients with diabetes per year. Overall, only 343 of 1092 audited patients (31%) had a bone health assessment. Osteoporosis was subsequently diagnosed in 92 of 343 (27%) patients.
Bone health was not assessed in most patients with diabetes. The results provide insight into current practices across diverse Asian centres and demonstrate the practical value of the audit tool kit. Participant feedback has been used to improve the tool kit. Results of this pilot audit are being used in the respective centres to inform quality improvement projects needed to overcome the gap in patient care.
本试点审计探讨了在亚洲各地不同中心，如何对糖尿病患者进行骨骼健康评估。在接受审核的 1092 名患者中，仅有 343 名（31%）接受了骨骼健康评估，其中 27%被诊断为骨质疏松症。需要采取质量改进策略来解决该领域患者护理方面的差距。
亚太骨质疏松症联盟（APCO）框架概述了评估和管理骨质疏松症的临床标准。一项试点审计评估了对临床标准 4 的遵守情况，该标准规定应评估存在与骨丢失和/或骨折风险增加相关疾病的患者的骨骼健康；本报告总结了该审计中糖尿病患者的结果。次要目的是评估 APCO 骨骼健康审核工具包的实用性和实际应用。
亚洲的 8 个中心参与了试点审计，选择糖尿病作为目标人群。参与者审查了至少 20 名连续接受目标疾病治疗的患者的实践记录。问题涵盖常规检查、骨骼健康评估、骨质疏松症诊断和患者转诊途径。数据以描述性方式进行总结。
参与者代表了来自印度、马来西亚、巴基斯坦、新加坡、中国台湾和越南的公立医院、大学医学中心和私人诊所，每年估计有 95000 名糖尿病患者。总体而言，在接受审核的 1092 名患者中，仅有 343 名（31%）接受了骨骼健康评估。随后在 343 名患者中诊断出 92 例（27%）骨质疏松症。
大多数糖尿病患者未进行骨骼健康评估。结果提供了对亚洲各地不同中心当前实践的深入了解，并展示了审核工具包的实用价值。参与者的反馈意见已用于改进工具包。该试点审计的结果正在各中心使用，以告知需要改进的项目，以克服患者护理方面的差距。
