Category: Calcium/Bone Disorders

Monitor: 9

9 - IMPROVING THE UTILIZATION OF DUAL X-RAY ABSORPTIOMETRY FOR OSTEOPOROSIS SCREENING IN THE RUTGERS ROBERT WOOD JOHNSON DEPARTMENT OF MEDICINE AMBULATORY PRACTICE

Saturday, Apr 27
11:00 AM – 11:30 AM

Objective :

Osteoporosis is a common disease affecting more than 10 million people in the United States. We aim to improve screening of osteoporosis with Dual X-ray absorptiometry (DXA) in our internal medicine and subspecialty clinics.


Methods : We reviewed national screening guidelines recommended by the National Osteoporosis Foundation and the American Association of Clinical Endocrinologists. With this information, we developed educational posters placed in our clinics to remind providers about osteoporosis risk factors that should prompt screening. Coding guidelines were included on these posters to ensure proper billing and insurance coverage for patients. In addition, a detailed questionnaire was created and provided to all clinic patients. The questionnaire inquired about risk factors for osteoporosis, including age, gender, social habits, family history, and any prior screening. The questionnaire results helped physicians determine if a patient met appropriate criteria for osteoporosis screening. Other initiatives included educational sessions held for all members of the health care team including front desk staff, medical assistants, nurses, and physicians, as well as electronic reminder messages for physicians.


Results : Prior to our interventions in November 2017, we discovered only 48% of our patients in our internal medicine and endocrine ambulatory practices had appropriate DXA screenings performed. Our post-intervention data revealed a sustained monthly increase of 67% in the number of DXA performed by month over a six-month time span (N=224 in 2017 vs. N=368 in 2018).


Discussion : Osteoporosis screening is important for initiation of treatment, assessment of fracture risk, and overall prevention of fractures in both men and women. Risk factors for developing osteoporosis include genetic predisposition, medications, various medical conditions, and lifestyle factors such as low calcium intake, vitamin D deficiency, smoking, and alcohol use. By using a multidisciplinary educational approach about osteoporosis screening that includes patients, we aimed to prevent fractures in our patient population. We believe that our sustained increase in DXA ordering and utilization over a six-month time span is a significant increase to meet these goals. Future prospects for this project include expanding the educational efforts and process flow improvement to all subspecialty departments within internal medicine as well as outside of internal medicine.


Conclusion : DXA utilization for osteoporosis screening is important for fracture prevention. A multidisciplinary approach focused on education of both providers and patients has shown a sustained improvement in DXA utilization at our institution.

SHORT URL FUNCTION-->

Shivani Vekaria

Resident Physician
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey

Internal Medicine Resident at Rutgers Robert Wood Johnson Medical School.

Priya Jaisinghani

Resident Physician
Rutgers Robert Wood Johnson Medical School

Internal Medicine Resident at Rutgers Robert Wood Johnson Medical School

Sumona Bhattacharya

Former Resident Physician
Rutgers Robert Wood Johnson Medical School

Former Internal Medicine Resident at Rutgers Robert Wood Johnson Medical School

Najaf Asrar

Endocrinology Fellow
Rutgers Robert Wood Johnson Medical School

Endocrinology Fellow at Rutgers Robert Wood Johnson Medical School.

Lourdes Marrero

DXA Technician
Rutgers Robert Wood Johnson Medical School

DXA Technician Rutgers Robert Wood Johnson Medical School

Kathleen Bolmer

Internal Medicine Department Nurse Manager
Rutgers Robert Wood Johnson Medical School

Internal Medicine Department Nurse Manager at Rutgers Robert Wood Johnson Medical School.

Diesha Stewart

Internal Medicine Clinic Service Representative
Rutgers Robert Wood Johnson Medical School

Internal Medicine Clinic Service Representative at Rutgers Robert Wood Johnson Medical School.

Julia Grimes

Internal Medicine Physician
Rutgers Robert Wood Johnson Medical School

Internal Medicine Physician at Rutgers Robert Wood Johnson Medical School

Anupa Sharma

Endocrinologist
Rutgers Robert Wood Johnson Medical School

Endocrinologist at Rutgers Robert Wood Johnson Medical School.

Payal Parikh

Internal Medicine Physician
Rutgers Robert Wood Johnson Medical School

Internal Medicine Physician at Rutgers Robert Wood Johnson Medical School.