Quality of Osteoporosis Care of Older Medicare Recipients with Fragility Fractures: 2006 to 2010

作者：Stephen K. Liu, Jeffrey C. Munson, John‐Erik Bell, Rebecca Zaha, John N. Mecchella, Anna N.A. Tosteson, Nancy E. Morden · 发表于：Journal of the American Geriatrics Society · 年份：2013 · DOI：10.1111/jgs.12507 · 被引用次数：50 · 研究领域：Bone health and osteoporosis research、Hip and Femur Fractures、Bone fractures and treatments

OBJECTIVES: To assess uptake of postfracture care guidelines in community-dwelling Medicare recipients with fractures. DESIGN: Retrospective observational cohort study. SETTING: Claims-based study using U.S. Medicare administrative inpatient, outpatient (2003-2010), and prescription (2006-2010) data. PARTICIPANTS: Individuals aged 68 and older who survived at least 12 months after a fracture of the hip, radius, or humerus. MEASUREMENTS: Poisson regression modeled factors, including participant characteristics, comorbidities and hospital referral region (HRR), associated with bone density testing or osteoporosis pharmacotherapy in the 6 months after fracture. Models were repeated for participants with no osteoporosis care observed before fracture (attention naïve). RESULTS: In 61,832 individuals with fractures, mean age was 80.6, 87.0% were female, 88.5% were white, 2.6% were black, and 62.1% were attention naïve at the time of fracture; 21.8% received testing, pharmacotherapy, or both in the 6 months after fracture. In adjusted models, factors associated with significantly lower likelihood of receiving this care were black race, male sex, and an upper extremity fracture (vs hip). In models restricted to attention-naïve participants, the same factors were associated with lower relative risk of receiving care. Adjusted HRR-level care rates ranged from 14.7% to 22.9% (10th to 90th percentile). The proportion receiving care increased from 2006 to 2009. CONCLUSION: Postfracture os...