Community-based Health System Research Articles

Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study.

Access to community-based specialist palliative care teams has been shown to improve patients' quality of life; however, the impact on health system expenditures is unclear. This study aimed to determine whether exposure to these teams reduces health system costs compared with usual care. We conducted a retrospective matched cohort study in Ontario, Canada, using linked administrative data. Decedents treated by 1 of 11 community-based specialist palliative care teams in 2009/10 and 2010/11 (the exposed group) were propensity score matched (comorbidity, extent of home care, etc.) 1 to 1 to similar decedents in usual care (the unexposed group). The teams are comprised of a core group of specialized physicians, nurses and other providers; their role is to manage symptoms around the clock, provide education and coordinate care. Our primary outcome was the overall difference in health system costs (among 5 health care sectors) between all matched pairs of exposed versus unexposed patients in the last 30 days of life. The total cohort of decedents included 3109 matched pairs. Among matched pairs, the mean health system cost difference was $512 (95% confidence interval [CI] -$641 to -$383) lower in the last 30 days among exposed than among unexposed patients. In the last 30 days, the mean home care costs of the exposed group were $189 higher (95% CI -$151 to $227) than those of the unexposed group, but their mean hospital costs were $733 lower (95% CI -$950 to -$516). Our study suggests that health system costs are lower for patients who have access to community-based specialist teams than for those who receive usual care alone, largely because of decreased hospital costs. Ensuring access to in-home palliative care support, as provided by these teams, is an efficacious strategy for reducing health care expenditures at the end of life.

Beta-Hemolytic Nongroup A Streptococcal Pharyngitis in Children

To evaluate the epidemiology, clinical features, and antibiotic prescribing patterns for nongroup A streptococci (NGAS) in children. Throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Epidemiologic and clinical features of children with NGAS were compared with children with group A Streptococcus (GAS) and negative cultures. Antibiotic prescribing patterns were evaluated. A total of 224 328 rapid streptococcal antigen tests and 116 578 throat cultures were performed. Clinical analysis was completed for 602 GAS-positive patients, 535 NGAS-positive patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season but increased with age from 2% at ≤5 years to 7% at 18 years of age. Patients with NGAS were more likely than those with negative cultures to have tonsillar exudate (20.3% vs 13.1%, P = .003) and enlarged tonsils (28.6% vs 19.3%, P < .001). Modified Centor scores did not differ between groups (score ≥2, P = 1.0; score ≥3, P = .50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs 24.5%, P = .003), palatal petechiae (14.0% vs 3.1%, P < .001), and modified Centor score ≥2 (47.8% vs 27.1%; P < .001). Of patients with NGAS, 65% were prescribed antibiotics. NGAS likely exist in both carriage and infectious states and incidence increases with age. Infections associated with NGAS are milder than with GAS, and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment.

1454. Β-Hemolytic Non-Group A Streptococcus Pharyngitis in Children

BackgroundNon-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. Few studies have assessed the epidemiology and clinical features of these infections in children.MethodsThe epidemiology, clinical features, and antibiotic prescribing patterns for NGAS among children with throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Children with NGAS were compared with children with Group A Streptococcus (GAS) and negative cultures using uni- and multi-variate analysis. Antibiotic prescribing patterns were evaluated.ResultsA total of 224,328 rapid Streptococcus tests and 116, 578 throat cultures were performed. Clinical analysis was completed for 602 GAS patients, 535 NGAS patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season, but increased with age from 2% at ≤ 5 years to 7% at 18 years. Patients with NGAS were more likely than those with negative cultures to have exudates (20.3% vs. 13.1%, P = 0.003) and enlarged tonsils (28.6% vs. 19.3%, P < 0.001). Modified Centor scores did not differ between groups (score>2, P = 1.0; score>3, P = 0.50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs. 24.5%, P = 0.003), petechiae (14.0% vs. 3.1%, P < 0.001) and modified Centor score >2 (47.8% vs. 27.1%; P < 0.001). Of patients with NGAS 65% were prescribed antibiotics.ConclusionNGAS likely exists in both a carriage and infectious state and the incidence increases with age. When NGAS causes infection the infection is milder than GAS and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment.Disclosures All authors: No reported disclosures.

Enhanced recovery after cardiac surgery program to improve patient outcomes.

This article details the obstacles of implementing a cardiac-specific enhanced recovery after surgery (ERAS) program in a 919-bed not-for-profit community-based health system and the benefits of ERAS programs for different patient populations.

Perceptions and experiences with low-dose computed tomography for lung cancer screening in a southeastern community-based health system

To test the hypothesis that diabetes-related factors (metabolic syndrome [MetS], glucose, insulin, and leptin) are inversely associated with abdominal aortic aneurysm (AAA) risk.We followed 13,736 participants, aged 45–64 years, without prior AAA surgery at baseline (1987–1989), for AAA occurrence through 2011. Hazard ratios (HRs) and their 95% confidence intervals (CIs) of AAA were calculated using Cox regression.During 275,054 person-years of follow-up, we identified 518 AAA events. Fasting serum glucose was associated inversely with AAA risk (HR [95% CI] per one unit increment in log2(glucose), 0.54 [0.36–0.80]), but fasting insulin was not associated with AAA. Plasma leptin was also associated inversely with AAA occurrence (HR [95% CI] per one unit increment in log2(leptin), 0.83 [0.71–0.98]). Compared with individuals without MetS, those with MetS had increased risk of AAA (HR [95% CI], 1.24 [1.04–1.48]). Among individuals with or without diabetes, the HRs increased monotonically with a greater number of non-glucose MetS components.Diabetes, fasting glucose, and plasma leptin were inversely associated with risk of AAA. In contrast, the MetS was associated with increased risk of AAA, due to the influence of the non-glucose MetS components.

Characterization of the onset of thyroid function (TF) abnormalities in patients receiving immune checkpoint inhibitor (CPI) therapy.

e22082 Background: Nivolumab (N), Pembrolizumab (P) and ipilimumab (I) are active cancer therapies, however; endocrinopathies are common immune-related adverse events (irAEs). The estimated incidence of TF abnormalities in patients receiving these agents is 10%. Methods: We performed a retrospective review of cancer patients who received CPI therapy with N, P, or I between July 2012 and November 2016 – for various indications- through our integrated community-based health system. The primary aim was to characterize the onset of TF abnormalities and the potential predictors of their development. Patients with pre-existing TF abnormalities, prior head and neck radiation, or prior thyroid surgery were excluded. TF abnormalities were classified as thyrotoxicosis (defined as low TSH, or an elevation of FT4 or FT3) or hypothyroidism (defined as an elevation in TSH, or a reduced level of FT4 or FT3). Patient demographics, diagnosis, treatment type, associated symptoms, and number of days before detection (NDBD) of TF abnormality were reviewed. Results: Of 361 eligible patients reviewed, 50 patients (13.85%) developed new onset of TF abnormalities. Among those with TF abnormalities, the median age at the time of receiving immunotherapy was 64. 29 patients (58%) received N, 12 received P (24%), 4 patients received I (8%), and 5 patients received N + I (10%). Thyrotoxicosis was the most commonly noted initial abnormality (n = 27, 54%), compared to hypothyroidism (n = 23,46%). Only 58% of patients had clinically evident symptoms. No significant difference was found between the mean of NDBD of TF abnormality between hypothyroidism and thyrotoxicosis (89 versus 78 days, P = 0.57). The time frame for TF abnormality detection was not significantly different between males and females receiving CPI therapy (71 versus 97 days, P = 0.17). Conclusions: The incidence of CPI related TF abnormalities at our center is similar to clinical trial findings. CPI therapy is associated with different patterns of TF abnormalities. The majority of patients who developed laboratory evidence of abnormal thyroid function were asymptomatic. Ongoing research is exploring the impact of these irAE on patient outcome.

Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.

Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.

Integrated mental health services in China: challenges and planning for the future.

Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

Outpatient Co-prescription of Ondansetron With Other QT-Prolonging Drugs in a Large Community-Based Health System: A Warning Ignored

Introduction: Ondansetron is a 5HT-3 serotonin receptor antagonist that is commonly used to treat nausea and vomiting. The FDA has warned of QT-prolonging effects of ondansetron, especially when combined with other QT-prolonging drugs, or in patients with known cardiac disease. Electronic medical records with warning systems for drug-drug interactions have been promoted for patient safety. We present a review of de-identified data from a large community-based health system to determine how providers responded to electronic warnings when prescribing ondansetron combined with other QT-prolonging drugs. Methods: All prescriptions for ondansetron in combination with QT-prolonging drugs at NorthShore University HealthSystem between January and March 2016 were included in the initial database as part of a quality improvement project. Inpatient orders and IV ondansetron orders were removed. The name and class of co-prescribed QT-prolonging drugs, warning severity, response to the warning by prescribing practitioner (over-ride warning and prescribe, or cancel order), reason for the warning over-ride, patient age and gender were evaluated. Results: There were a total of 9203 episodes of co-prescription of ondansetron and another QT-prolonging drug in 2739 adult patients during the study time period. After filtering, there were 770 outpatient co-prescriptions in 500 patients. Mean patient age was 46.2 years (range 18 to 90 years). Orders were for 592 females (76.8%) and 178 males (33.2%). All warnings were considered “major interactions”. Most orders, 651 (84.5%) prescriptions were administered, while only 119 (15.5%) orders were canceled. The most common classes of co-prescribed QT-prolonging drugs were macrolide antibiotics (40.0%), flouroquinolone antibiotics (17.0%), SARI antidepressants (13.4%), and SSRI antidepressants (9.9%), (Table 1). There were nine (1.4%) cases of co-prescriptions with antiarrhythmic drugs (amioderone and flecainide). The most commonly co-prescribed QT-prolonging medications were azithromycin, levofloxacin, and trazadone (Table 2). Reasons for warning overrides were “benefit outweighs risk” in 266 (40.8%) and “not clinically significant” in 116 cases (17.7%).Table: Table. Classes of Drugs Co-Prescribed with OndansentronTable: Table. List of Drugs Co-Prescribed with OndansetronConclusion: After viewing warnings, practitioners still prescribed ondansetron with other QT-prolonging drugs 85% of the time. This form of co-prescription with ondansetron neglects FDA recommendations and could put patients at risk for cardiac arrhythmias.

Mental health law in Ghana.

In 2012 Ghana passed a new Mental Health Act, which aimed to create a new system of mental healthcare in Ghana. The Act includes provisions for the creation of a modern, community-based mental health system and for the protection of the rights of persons with mental disorders. This article discusses the implications of the Act and the progress which has been made towards its implementation.

Prostate Multiparametric Magnetic Resonance Imaging Program Implementation and Impact: Initial Clinical Experience in a Community Based Health System

IntroductionMagnetic resonance imaging of the prostate is increasingly being performed at academic centers but implementation in community based health systems has lagged and literature regarding clinical impact in this setting is limited. We describe our experience developing a community based prostate magnetic resonance imaging program, including the evolution of interpretation and reporting methods, and the resulting clinical impact during a period of more than 5 years (August 2010 to December 2015). MethodsData collected for prostate magnetic resonance imaging included demographic, clinical, scanning, pathology and treatment/management information. Suspicion level on prostate magnetic resonance imaging was correlated with pathology results when available. Outcomes were compared across 3 reporting eras, ie early, mid and Prostate Imaging Reporting and Data System, version 2. ResultsA total of 537 prostate magnetic resonance images were obtained for diagnosed prostate cancer (60%) or screening (37%). During the study period the number of scans and ordering physicians increased. The proportion of patients with suspected extraprostatic extension (17.5%), lymph node metastasis (6.9%) and bone/other metastasis (4.3%) on prostate magnetic resonance imaging remained relatively constant. When stratified by era, there was a significant increase in low suspicion studies (p = 0.0002) and a trend toward a significant increase in cancer detection at biopsy (p = 0.09), reflecting increased specificity in the Prostate Imaging Reporting and Data System, version 2 era. ConclusionsWhile staging information with prostate magnetic resonance imaging was accurate early in the implementation of the program, lesion characterization improved with use of Prostate Imaging Reporting and Data System, version 2 criteria and standardized reporting. Regular multidisciplinary participation in community based prostate magnetic resonance imaging programs may maximize clinical impact.

Prevalence of Proteinuria and Other Abnormalities in Urinalysis Performed in the Urology Clinic

To compare the prevalence of proteinuria in the urology clinic with other outpatient settings. Chronic kidney disease is classified according to cause, glomerular filtration rate, and proteinuria. Proteinuria may be more prevalent in patients with known chronic kidney disease, renal disorders (benign or malignant), or after urologic surgery. A cross-sectional study of 3 populations undergoing urinalysis (UA) testing was carried out: general outpatients (n = 20,334), urology outpatients (n = 5023), and kidney cancer patients (n = 1016). Proteinuria was classified under Kidney Disease: Improving Global Outcomes guidelines: A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). Proteinuria was detected throughout a community-based health system in 8.6% of UA (8.2%: A2; 0.4%: A3). In comparison, 18.6% of urology office-performed UA had proteinuria (16.0%: A2, 2.5%: A3) (P < .0001 vs non-urology). Kidney cancer patients were more likely to have proteinuria (17.9%: A2, 3.8%: A3). The proportion with A3 was significantly higher in urology and kidney cancer patients when compared with other outpatients (each P < .0001), and in the kidney cancer subgroup compared with all urology patients (P < .0001). Additional abnormalities were frequently present on microscopic analysis of UA in the urology clinic, including hematuria (20.9%), pyuria (21.8%), and bacteriuria (3.1%). The value of UA in the urology clinic as a screening test for proteinuria and other conditions appears high, with >56% having at least 1 abnormality. The population risk of proteinuria in the urology clinic is 18.5%, which is higher than that observed in non-urology clinics. Patients with kidney cancer appear more likely to have proteinuria than the average urology patient. We recommend evaluation of urology patients with UA to identify proteinuria.

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

BackgroundTrained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities.MethodsA descriptive observational study design used mixed methods to collect data from CHWs (structured survey, n = 60; focus group discussions, n = 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records.ResultsCoverage for community-based treatment of child diarrhea and pneumonia continued throughout the outbreak in project areas. A slight decrease in cases treated during the height of the outbreak, from 50 to 28% of registers with at least one treatment per month, was attributed to directives not to touch others, lack of essential medicines and fear of contracting Ebola. In a climate of distrust, where health workers were reluctant to treat patients, sick people were afraid to self-identify and caregivers were afraid to take children to the clinic, CHWs were a trusted source of advice and Ebola prevention education. These findings reaffirm the value of recruiting and training local workers who are trusted by the community and understand the social and cultural complexities of this relationship. “No touch” integrated community case management (iCCM) guidelines distributed at the height of the outbreak gave CHWs renewed confidence in assessing and treating sick children.ConclusionsInvestments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and “no touch” iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended.

From Brain Disease to Brain Health: Primary Prevention of Alzheimer's Disease and Related Disorders in a Health System Using an Electronic Medical Record-Based Approach.

Alzheimer's disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported. We aim to primarily prevent Alzheimer's disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance. We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention. A Community Based Health System. In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer's disease and related disorders. We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR. This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients. We are translating research into primary prevention of Alzheimer's disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.

Not Just Lady Windermere: Epidemiology of Non-Tuberculous Mycobacterial Pulmonary Infections at a Community-Based Health System

Not Just Lady Windermere: Epidemiology of Non-Tuberculous Mycobacterial Pulmonary Infections at a Community-Based Health System

Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States.

To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice. This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older undergoing hysterectomy from June 2011 to May 2014 in a large integrated health care delivery system. The primary outcome was the change in rate of opportunistic salpingectomy over time and after a systemwide practice recommendation was issued in May 2013. Secondary outcomes included data on blood loss, operating time, and length of stay. Of the 12,143 hysterectomies performed over the 3-year study period, 7,498 were performed without oophorectomy. There was a statistically significant rise in rate of salpingectomy over time from 14.7% for June 2011 to May 2012 to 44.6% from June 2012 to May 2013 and to 72.7% from June 2013 to May 2014 (P<.001). Sixty-one percent of laparoscopic hysterectomies were performed with salpingectomy, whereas only 25% of abdominal and 17% of vaginal hysterectomies had salpingectomies. Median estimated blood loss was lower in the salpingectomy group, 100 compared with 150 mL (P<.01). There was a significantly shorter median operating time (147 compared with 154 minutes, P=.002) for laparoscopic hysterectomy with bilateral salpingectomy compared with laparoscopic hysterectomy alone. Rates of salpingectomy increased significantly over time, consistent with the high reported acceptance rate reported by health care providers and highlighting the importance of physician education to improve compliance with risk-reducing clinical strategies.

Are U.S. physicians performing salpingectomy? Experience with incorporation of opportunistic salpingectomy in a large community-based health system

Are U.S. physicians performing salpingectomy? Experience with incorporation of opportunistic salpingectomy in a large community-based health system

Salpingectomy trends and physician attitudes towards salpingectomy in a community-based health system in northern California

Salpingectomy trends and physician attitudes towards salpingectomy in a community-based health system in northern California

Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act.

BackgroundPractice recommendations for mammography screening were issued by the U.S. Preventive Services Task Force in 2009 and expansion of insurance coverage was provided under the Patient Protection and Affordable Care Act soon thereafter, yet the influence of these changes on screening practices in the United States is not known.MethodsTo determine changes in mammography screening and their associations with new practice recommendations and the Affordable Care Act, we examined patient-level data from 249,803 screening mammograms from January 1, 2008 through December 31, 2012 in a large community-based health system in the northwestern United States. Associations were determined by an intervention analysis of time-series data method.ResultsAmong women screened, 64% were age 50-74 years; 84% self-identified as white race; 62% had commercial insurance; and 70% were seen in facilities located in metropolitan areas. Practice recommendations were associated with decreased screening volumes among women age <40 (-37.4 mammograms/month; -39.4% change; P<0.001), 40-49 (-106.0 mammograms/month; -11.2% change; P<0.001), and ≥75 (-54.7 mammograms/month; -10.0% change; P<0.001), but not women age 50-74. Implementation of the Affordable Care Act was associated with increased screening among women age 50-74 (+184.3 mammograms/month; +7.2% change; P=0.001), but not women <40 or ≥75; increases for age 40-49 were of borderline statistical significance (+56.9 mammograms/month; +6% change; P=0.06). Practice recommendations were also associated with decreased screening for women with commercial insurance, while the Affordable Care Act was associated with increased screening for women with Medicare, Medicaid, or other noncommercial sources of payment.ConclusionsMammography screening volumes in a large community health system decreased among women age <50 and ≥75 in association with new U.S. Preventive Services Task Force practice recommendations, while insurance coverage changes under the Affordable Care Act were associated with increased screening volumes among women age 50-74.

Osteoporosis risk and management in BRCA1 and BRCA2 carriers who undergo risk-reducing salpingo-oophorectomy

ObjectiveCharacterize current management of osteoporosis risk in BRCA carriers following risk-reducing salpingo-oophorectomy (RRSO). MethodsWomen with a BRCA1 or BRCA2 mutation who underwent RRSO were identified from a community-based health system in Northern California from 1995 to 2012. Retrospective chart review using the electronic medical record was performed. The primary outcome was the number of women who had a dual-energy X-ray absorptiometry scan post-RRSO. Secondary outcomes included new diagnoses of osteopenia, osteoporosis, and fracture. Information on the following risk factors was also recorded: calcium and vitamin D use, history of breast cancer, chemotherapy, use of aromatase inhibitors, and use of hormone replacement therapy. ResultsTwo hundred and twenty five women tested positive for a BRCA1 or BRCA2 mutation and underwent RRSO. Median follow-up was 41months from testing. Ninety-nine (44.0%) had at least one DXA scan following testing. The median time from RRSO to a diagnosis of bone disease was 29months (range 1–170). Seventy-two percent had only one DXA scan (range 1–7) following testing. Thirty-two percent had normal results, 55.6% had osteopenia and 12.1% had osteoporosis. Four percent of women had an atraumatic fracture after surgery. Age, breast cancer history, prior chemotherapy, and tamoxifen or aromatase inhibitor (AI) use were not associated with having osteoporosis or osteopenia. ConclusionsWomen with BRCA mutations who undergo RRSO have many risk factors for bone loss. The majority of these women are not being screened for bone loss. A clear guideline for screening needs to be established to improve detection of post-RRSO bone disease.