PS3-23: Osteoporosis Treatment in a Home Health Care Population

Abstract

Background and Aims: Only a small proportion of home health care patients at risk for fracture receive appropriate treatment. Patients with more comorbidities are least likely to receive treatment. The purpose of this study was to examine osteoporosis prevention and treatment among home health care (HHC) patients at risk for fragility fracture. Methods: All patients who received HealthPartners Integrated Home Care services in 2006 were identified. ICD-9 diagnosis codes & pharmaceutical data were examined between 1/1/04–12/31/05 to determine risk status (high vs. average). Patients with a diagnosis of osteoporosis, osteopenia, or Vitamin D deficiency, a history of previous fragility fracture, stroke or those taking a glucocorticoid (at least two orders) were categorized as high risk. Pharmaceutical data (e.g., estrogen, bisphosphonates) was obtained during the same two-year period to determine treatment status. Descriptive statistics were used to document proportion at high risk, with each risk factor and proportion of high risk receiving treatment. Inferential statistics (Pearson’s chi square, Fischer’s exact test) tested differences in characteristics (age, gender, race, number of comorbidities) among high risk patients with and without treatment. Results: A total of 2798 patients were in HHC during this timeframe. Of these, 754 were high risk and 2044 average risk. Approximately one-third (34%, 259 of 754) of high risk patients received osteoporosis medication compared to 4% (85 of 2044) of average risk (p<0.0001). We found no treatment differences based on age. Those with higher comorbidity profiles were less likely to receive treatment (28% or 121 of 435 vs. 72% or 314 of 435, p<0.0001). Conclusions: Only a small proportion of home health care patients at risk for fracture received adequate treatment. Patients with more comorbidities were least likely to receive treatment. The home health environment presents a good context in which an intervention to improve the quality of care for those at risk for fracture can be accomplished. Since the individuals identified are receiving medical and nursing care within an integrated healthcare delivery system, an opportunity exists to develop a program to increase treatment rates for those at greatest risk.