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      Osteoporosis Best Practices Learning Collaborative 2.0

      Background

      Osteoporosis Care: Challenges and Opportunities

      Osteoporosis often goes undiagnosed until a fracture occurs,1 significantly impacting postmenopausal women’s quality of life and economic stability.2 Two in three women with postmenopausal osteoporosis who are at high risk for fracture will experience a fracture in their lifetime.3 Yet, only 9% of Medicare beneficiaries receive a bone density test after a fracture,4 and fewer than 20% are treated.5 These care gaps emphasize the need for improved early diagnosis and care.6

      Program Overview

      The Osteoporosis Best Practices Learning Collaborative 2.0 builds upon the initial collaborative (1.0), which revealed critical care gaps in osteoporosis diagnosis, treatment, and DXA testing rates among women. Collaborative 2.0 focuses on improving osteoporosis care for female patients by implementing standardized practices and expanding provider, staff, and patient education.

      Focus

      1. Improve DXA Testing Rates: Increase osteoporosis screening for women aged 65–90
      2. Improve Diagnosis: Diagnose osteoporosis in women aged 50–90 meeting diagnostic criteria
      3. Increase Treatment Rates: Provide treatment to diagnosed women and those with prior fractures
      4. Standardize Care: Establish workflows for osteoporosis screening, diagnosis, and treatment across healthcare organizations (HCOs)

      Key Interventions


      Provider and Staff Education:

      Equipping Clinicians with Tools and Knowledge

      • Intervention: Expanded osteoporosis diagnosis capture by training providers on workflows using Epic tools like Best Practice Advisories (BPA), health maintenance, and SmartSets.

      • Tip: Engage specialty leadership throughout the network in capturing the diagnosis of osteoporotic fractures and educating them on available tools, as this is essential.

      • Intervention: Enhanced osteoporosis screening and management through continuing certification, incorporating patient stories, educational resources, and practice reviews.

      • Tip: Begin with fundamental concepts and share patient stories to effectively engage clinicians and care teams.

      Patient Education & Engagement:

      Empowering Patients with Awareness and Knowledge
      • Intervention: Provided ongoing provider education on osteoporosis management and introduced bulk patient education materials on osteoporosis treatment.
      • Intervention: Developed a social media series and website educational posts to inform patients about osteoporosis risks and preventive measures.
      • Tip: Leverage existing technology to achieve your goals.

      Expanded Access to Care:

      Enhancing Capacity to Deliver Timely Care
      • Intervention: Increased bone health clinic appointment hours and introduced nurse visits for Prolia administration to free provider time for new patients.
      • Tip: Utilize clinical staff to the full extent of their licensure to create increased capacity.
      • Intervention: Collaborated with local hospitals and orthopedic groups to identify fracture patients, improve workflows, and provide timely treatment.
      • Tip:  Secure staff buy-in before implementation of new workflows

      Team-Based Collaboration & Coordination:

      Multidisciplinary Approach Involving Primary Care and Specialties
      • Intervention: Launched a Fracture Liaison Service (FLS) for integrated care across primary care, orthopedics, and endocrinology, ensuring consistent post-fracture management.
      • Intervention: Created an RN navigation program for osteoporotic fractures, standardized resources, and implemented specialty workflows to identify high-risk patients.
      • Tip: A team-based approach is crucial—Identify and involve all departments that can have an impact to improve outcomes.
      • Intervention: Implemented screening and post-screening workflows, engaging departments to disseminate resources for early osteoporosis diagnosis and treatment.
      • Tip: Even when communication efforts seem sufficient, additional outreach can be beneficial.

      Clinical Decision Support and Technology Integration: 

      Leveraging IT for Streamlined Workflows
      • Intervention: Built a risk-stratification model in Epic to identify high-risk patients, deployed clinical pharmacists in clinics for patient education and to provide support to clinicians, and used Epic Campaigns to automate outreach.
      • Tip: Leverage information technology efficiently to identify and screen patients at high risk for fractures
      • Intervention: Scaled work bench reports from osteoporosis screening to include treatment and adherence initiatives.
      • Tip: Develop IS infrastructure benefits from a multidisciplinary, multispecialty team approach.

      Reach and Impact:

      Across 8 Healthcare Organizations
      • 119,000 have been screened, 17,000 increase over 3 years.  
      • 54,000 treated for osteoporosis, 5,000 increase over 3 years.

      Building on Progress to Improve Outcomes

      The Osteoporosis Best Practices Learning Collaborative 2.0 improved DXA testing, diagnosis, and treatment rates through education, technology, and expanded access to care. Continued efforts to expand screenings, leverage innovation, and standardize care are key to ensuring timely treatment for patients at risk for osteoporosis related fractures.

      References

      1. https://www.niams.nih.gov/health-topics/osteoporosis
      2. Tajeu GS, et al. J Gerontol A Biol Sci Med Sci. 2014;69:346-353
      3. ASBMR 2024 Toronto, CA
      4. Hansen D, et al. Milliman Research Report. March 2021
      5. Boytsov NN, et al. Am J Med Qual. 2017;32:644-654
      6. https://www.niams.nih.gov/health-topics/osteoporosis