Faculty Collaboration Database

A program with a dedicated coordinator improved chart documentation of osteoporosis after fragility fracture. Osteoporos Int 2007 Aug;18(8):1127-36

Date

03/03/2007

Pubmed ID

17333450

DOI

10.1007/s00198-007-0341-0

Scopus ID

2-s2.0-34347370300 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

UNLABELLED: Post-fracture osteoporosis care is becoming recognized as essential by the orthopaedic community, but programs and systems are needed to ensure that this care is routinely provided. Chart documentation related to OP, which is valuable for continuity of care, increased significantly following establishment of an osteoporosis program with a dedicated coordinator.

INTRODUCTION: Post-fracture osteoporosis (OP) care has been repeatedly reported to be inadequate. Through a coordinator-based program, we addressed OP care for more than 95% of fragility fracture patients (1), but we do not know if documentation by orthopaedic surgeons improved. The literature suggests that chart documentation, though underestimating true care, is an indicator of the salient aspects of a condition. Thus chart documentation could be used to reflect an emerging recognition of OP as an important issue to be addressed in the orthopaedic management of the fragility fracture. The purpose of this study was to evaluate if there was an increased documentation of OP by orthopaedic surgeons before and after introduction of a coordinator-based program where the coordinator was known to address OP in 95% of cases.

METHODS: Chart audits were conducted to quantify OP documentation for patients treated after program initiation compared with age-, sex-, and fracture type-matched controls who presented prior to program implementation. Documentation rates were compared using chi(2) tests. Multivariable logistic regression analyses were performed to identify patient characteristics associated with OP-related documentation.

RESULTS: After program implementation, chart documentation of OP diagnosis (unadjusted OR 2.2, 95% CI 1.1-4.4), of referral for OP follow-up (unadjusted OR 3.1, 95% CI 1.5-6.1), and of initiation of OP management (unadjusted OR 8.2, 95% CI 4.0-16.5) by orthopaedic surgeons was more likely. Being in the post-implementation group was stronger than any patient factors in predicting OP charting.

CONCLUSIONS: Physicians working in a clinic with a coordinator-based OP program were more likely to document OP-related care in patients' medical charts. We believe this in turn reflected increased attention to OP by physicians in the orthopaedic management of fragility fractures.

Author List

Ward SE, Laughren JJ, Escott BG, Elliot-Gibson V, Bogoch ER, Beaton DE

Author

Benjamin G. Escott MBBS Associate Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Continuity of Patient Care
Female
Fractures, Spontaneous
Hip Fractures
Humans
Male
Medical Records
Middle Aged
Osteoporosis
Osteoporosis, Postmenopausal
Prognosis
Referral and Consultation
Risk Assessment
Wrist Injuries