Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
Research ArticleResearch Letter

Optimizing Fracture Prevention in Patients with Osteoporosis

Cheryl Lambing, Anna Moll and Michael Hite
The Journal of the American Board of Family Medicine November 2015, 28 (6) 819-821; DOI: https://doi.org/10.3122/jabfm.2015.06.150082
Cheryl Lambing
From the Ventura County Health Care Agency, Family Medicine Residency Program, Ventura County Medical Center, Ventura, CA (CL); the Annenberg Center for Health Sciences at Eisenhower Medical Center, Rancho Mirage, CA (AM, MH).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anna Moll
From the Ventura County Health Care Agency, Family Medicine Residency Program, Ventura County Medical Center, Ventura, CA (CL); the Annenberg Center for Health Sciences at Eisenhower Medical Center, Rancho Mirage, CA (AM, MH).
MBA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Hite
From the Ventura County Health Care Agency, Family Medicine Residency Program, Ventura County Medical Center, Ventura, CA (CL); the Annenberg Center for Health Sciences at Eisenhower Medical Center, Rancho Mirage, CA (AM, MH).
MFA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

Purpose: This Maintenance of Certification activity was designed to help address gaps in osteoporosis management, provide practice improvement based on recognized models, and evaluate the impact of the initiative.

Methods: The program comprised 3 stages: stage A, practice self-assessment and chart review; stage B, an intervention to address at least 1 problem; and stage C, additional chart review (new patients). Data from stages A and C were compared to evaluate the impact of the activity.

Results: Of 217 registrants, 62 completed the program, reviewing 2107 and 1814 charts in stages A and C, respectively. Statistically significant improvements occurred in all quality attributes from stage A to stage C in 6 specified domains, except for the proportion of patients with an osteoporosis diagnosis.

Conclusions: Results of this activity support the benefit of performance improvement initiatives and are consistent with other reports.

  • Certification
  • Osteoporosis
  • Quality Improvement
  • Quality of Health Care

Mandatory changes in board certification requirements, that is, Maintenance of Certification (MOC), have resulted in quality care and performance improvement initiatives and programs. Published data supporting behavioral changes resulting from such programs are limited. The MOC activity reported here was designed to address gaps in osteoporosis management, provide practice improvement based on recognized models for such activities (eg, the METRIC Diabetes Module offered by the American Academy of Family Physicians),1 and evaluate the impact of the activity in improving practice attributes and adherence to national standards of care. The results of this initiative are presented herein, adding to data demonstrating that this approach can be effective in changing practice.

Methods

This online activity was developed by the Annenberg Center for Health Sciences at Eisenhower Medical Center (Rancho Mirage, CA). The Annenberg Center has been approved by the American Board of Family Medicine for this activity as an external provider of MOC for Family Physicians Part IV credit. The Annenberg Center is also accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The activity comprised 3 stages. In stage A, physicians assessed practice attributes for 6 domains (such as organization, community linkages, and clinical information systems) and conducted chart reviews to establish their baseline on 4 quality measures derived from the Physicians Consortium for Performance Improvement library of measures and developed from national practice guidelines2 (Table 1). Patients for chart review had to be women aged ≥65 years, men or women aged ≥50 years who had had a fracture of the hip, spine, or distal radius; or men or women aged ≥50 years who had an established diagnosis of osteoporosis. In stage B, participants selected an intervention (prespecified or their own action item) to address at least 1 problem area. After at least 1 month, participants conducted additional chart reviews for a different set of patients meeting the same criteria (stage C) to assess practice and performance changes from stage A. Data from stages A and C were compared.

View this table:
  • View inline
  • View popup
Table 1. Comparison of Stage A and Stage C Results

Results

Of 217 physicians who registered between December 28, 2011, and October 31, 2013, 62 completed stages A, B, and C of the performance improvement module, reviewing 2107 and 1814 charts in stages A and C, respectively. Positive shifts occurred in practice attributes from stage A to stage C across all 6 domains. For example, when assessing the organization of the practice, 66% of the responses in stage A were that the approach to osteoporosis is not systematic. In stage C, that percentage was 39%, a decrease (improvement) of 27 percentage points. Significant improvements occurred in all quality attributes from stage A to stage C, except for the proportion of patients with an osteoporosis diagnosis (Table 1). When results were reanalyzed for each outcome using cluster adjustment to account for physician variation, all comparisons remained significantly different. All differences in outcome variables between stages A and B also remained significant in the multivariate model that adjusted for age, sex, and previous fracture. Participants who evaluated the program rated it highly across all stages. Program ratings on all questions ranged from 4.7 to 5.4, with 6 being the highest and 1 the lowest.

Conclusions

This practice improvement intervention to optimize fracture prevention resulted in significant improvements in all key performance measures other than the percentage of patients receiving a diagnosis of osteoporosis. Results were consistent with other practice improvement initiatives for osteoporosis and other areas of medicine.3⇓–5 Improvements demonstrated in this activity support the benefit of performance improvement initiatives and provide a foundation for ongoing research including associations between performance improvement and health outcomes.

Acknowledgments

Philip A. Dombrowski, MBA, then president and CEO, The Annenberg Center for Health Sciences at Eisenhower Medical Center, Rancho Mirage, CA, was involved in program conceptualization, development, and implementation. Editorial assistance was provided by Paula G. Davis, PhD, Medical Communications, Inc., Tequesta, FL, and Kathleen Major, KMajor Editorial Services, Mahwah, NJ. Statistical analyses were conducted by Martin L. Lee, PhD, CStat, CSci, Adjunct Professor, Biostatistics, UCLA School of Public Health, Los Angeles, CA.

Notes

  • This article was externally peer reviewed.

  • Funding: The costs related to the technology platform for the project were supported through an educational donation provided by Amgen (HCCOPS-25223). The Annenberg Center for Health Sciences at Eisenhower Medical Center provided management support and funded the costs of content development.

  • Conflict of interest: none declared.

  • Received for publication February 26, 2015.
  • Revision received April 29, 2015.
  • Accepted for publication May 4, 2015.

References

  1. 1.↵
    1. Peterson LE,
    2. Blackburn BE,
    3. Puffer JC,
    4. Phillips RL Jr.
    . Family physicians' quality interventions and performance improvement through the ABFM diabetes performance in practice module. Ann Fam Med 2014;12:17–20.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    American Medical Association, National Committee for Quality Assurance. Osteoporosis Physician Performance Measurement Set. (CPT Copyright 2008). Chicago IL. American Medical Association;2009;1–18.
  3. 3.↵
    1. Hess BJ,
    2. Johnston MM,
    3. Iobst WF,
    4. Lipner RS
    . Practice-based learning can improve osteoporosis care. J Am Geriatr Soc 2013;61:1651–60.
    OpenUrlPubMed
  4. 4.↵
    1. Hirsch FR,
    2. Jotte RM,
    3. Berry CA,
    4. Mencia WA,
    5. Stowell SA,
    6. Gardner AJ
    . Quality of care of patients with non-small-cell lung cancer: a report of a performance improvement initiative. Cancer Control 2014;21:90–7.
    OpenUrlPubMed
  5. 5.↵
    1. Peterson LE,
    2. Blackburn B,
    3. Phillips RL,
    4. Puffer JC
    . Improving quality of care for diabetes through a maintenance of certification activity: family physicians' use of the chronic care model. J Contin Educ Health Prof 2014;34:47–55.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 28 (6)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 6
November-December 2015
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Optimizing Fracture Prevention in Patients with Osteoporosis
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 10 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Optimizing Fracture Prevention in Patients with Osteoporosis
Cheryl Lambing, Anna Moll, Michael Hite
The Journal of the American Board of Family Medicine Nov 2015, 28 (6) 819-821; DOI: 10.3122/jabfm.2015.06.150082

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Optimizing Fracture Prevention in Patients with Osteoporosis
Cheryl Lambing, Anna Moll, Michael Hite
The Journal of the American Board of Family Medicine Nov 2015, 28 (6) 819-821; DOI: 10.3122/jabfm.2015.06.150082
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Conclusions
    • Acknowledgments
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • New Tools and Approaches for Family Physicians
  • Google Scholar

More in this TOC Section

  • Timing of Certification Stage Completion Associated with Subsequent Certification Exam Outcomes Among Board-Certified Family Physicians
  • Interpersonal Continuity of Care May Help Delay Progression to Type 2 Diabetes
  • Impact of Point of Care Hemoglobin A1c Testing on Time to Therapeutic Intervention
Show more Research Letters

Similar Articles

Keywords

  • Certification
  • Osteoporosis
  • Quality Improvement
  • Quality of Health Care

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire