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  • Measure Summary
  • NQMC:010345
  • Jun 2015

Osteoporosis: percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing.

National Committee for Quality Assurance (NCQA). Osteoporosis: communication with the physician or other clinician managing on-going care post fracture for men and women aged 50 years and older. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Jun 5. 3 p.

This is the current release of the measure.

This measure updates a previous version: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American Association of Clinical Endocrinologists, American College of Rheumatology, The Endocrine Society, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Osteoporosis physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2009 Nov. 18 p.

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Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing.

This measure is reported by the physician who treats the fracture and who therefore is held accountable for the communication.

Rationale

The single most powerful predictor of a future osteoporotic fracture is the presence of previous such fractures. Up to 50% of patients who suffer a first osteoporotic fracture will experience a subsequent fragility fracture during their life, often as early as 1 to 2 years after the first fracture (Center et al., 2007). Follow-up care after a fracture can substantially reduce the risk of re-fracture. However, the majority of patients with incident osteoporotic fractures are still not investigated or treated for their underlying condition (Giangregorio et al., 2006). Patients who experience fragility fractures should either be treated or screened for the presence of osteoporosis. Although the fracture may be treated by the orthopedic surgeon or hospitalist, the testing and/or treatment for osteoporosis is likely to be under the responsibility of a physician or clinician providing on-going care. It is important the physician or other clinician providing on-going care for the patient be made aware the patient has sustained a non-traumatic fracture. This measure aims to improve communication and coordination from the physician treating the fracture in the acute setting to the physician or clinician responsible for follow-up care of osteoporosis.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

The single most powerful predictor of a future osteoporotic fracture is the presence of previous such fractures, yet rates of investigation and treatment of osteoporosis in fragility fracture patients remain low (Elliot-Gibson et al., 2004), despite clear clinical practice guidelines calling for such treatment:

The American Society of Clinical Endocrinologists (AACE) (Watts et al., 2010): Recommends pharmacologic treatment for postmenopausal women with a hip or spine fracture (either clinical spine fracture or radiographic fracture).

The National Osteoporosis Foundation (NOF) (Cosman et al., 2014): Recommends that all postmenopausal women 50 and older who have had a hip or vertebral fracture be treated for osteoporosis. The most common fractures are those of the vertebrae (spine), proximal femur (hip) and distal forearm (wrist). However, most fractures in older adults are due at least in part to low bone mass, even when they result from considerable trauma. The most notable exceptions are those of the fingers, toes, face and skull, which are primarily related to trauma rather than underlying bone strength.

Better communication and care coordination between the physician treating the initial fracture and physician or care team responsible for on-going management of the patient's condition has been found to improve patient outcomes and reduce costs (Bogoch et al., 2006; Marsh et al., 2011).

Evidence for Rationale

Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM. Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am. 2006 Jan;88(1):25-34. PubMed External Web Site Policy

Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007 Jan 24;297(4):387-94. PubMed External Web Site Policy

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. PubMed External Web Site Policy

Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int. 2004 Oct;15(10):767-78. PubMed External Web Site Policy

Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006 Apr;35(5):293-305. PubMed External Web Site Policy

Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, McLellan AR, Mitchell PJ, Sale JE, Wahl DA, IOF CSA Fracture Working Group. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int. 2011 Jul;22(7):2051-65. PubMed External Web Site Policy

National Committee for Quality Assurance (NCQA). Osteoporosis: communication with the physician or other clinician managing on-going care post fracture for men and women aged 50 years and older. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Jun 5. 3 p.

Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, Kleerekoper M, Luckey MM, McClung MR, Pollack RP, Petak SM, AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract. 2010 Nov-Dec;16(Suppl 3):1-37. [209 references] PubMed External Web Site Policy

Primary Health Components

Osteoporosis; fracture; physician communication; care coordination

Denominator Description

Adults aged 50 years and older who experienced a fracture, except fractures of the finger, toe, face or skull (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients with documentation of communication with the physician or other clinician managing the patient's on-going care that a fracture occurred and that the patient was or should be considered for osteoporosis testing or treatment (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Care coordination

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Transition

Type of Care Coordination

Coordination across provider teams/sites

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 50 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Effective Communication and Care Coordination
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

The reporting period

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Adults aged 50 years and older who experienced a fracture, except fractures of the finger, toe, face or skull

Note: Refer to the original measure documentation for administrative codes.

Exclusions
Unspecified

Exceptions

  • Documentation of medical reason(s) for not communicating with the physician managing the on-going care of patient that a fracture occurred and that the patient was or should be tested or treated for osteoporosis
  • Documentation of patient reason(s) for not communicating with the physician managing the on-going care of patient that a fracture occurred and that the patient was or should be tested or treated for osteoporosis

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients with documentation of communication with the physician or other clinician managing the patient's on-going care that a fracture occurred and that the patient was or should be considered for osteoporosis testing or treatment

Note:

  • Communication may include documentation in the medical record indicating that the clinician treating the fracture communicated (e.g., verbally, by letter, through shared electronic health record, a bone mineral density test report was sent) with the clinician managing the patient's on-going care a copy of a letter in the medical record outlining whether the patient was or should be treated for osteoporosis.
  • Refer to the original measure documentation for administrative codes.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #24: communication with the physician or other clinician managing on-going care post fracture for men and women aged 50 years and older.

Measure Collection Name

Osteoporosis

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Osteoporosis Work Group: Steven Petak, MD, JD, FACE (Co-chair); Kenneth Saag, MD, MSc (Co-chair); Robert Adler, MD; C. Conrad Johnston, Jr., MD; H. Chris Alexander, III, MD, FACP; Joseph Lane, MD; Donald Bachman, MD, FACR; Leon Lenchik, MD; Joel Brill, MD; Bonnie McCafferty, MD, MSPH; Jan Busby-Whitehead, MD; Michael Maricic, MD; Thomas Dent, MD; Michael L. O'Dell, MD, MSHA, FAAFP; Nancy Dolan, MD; Sam J. W. Romeo, MD, MBA; Leonie Gordon, MB, ChB; Frank Salvi, MD, MS; Tomas Griebling, MD; Joseph Shaker, MD; Richard Hellman, MD, FACP, FACE; Madhavi Vemireddy, MD; Marc C. Hochberg, MD, MPH; David Wong, MD, MSc, FRS(C)

American Academy of Family Physicians: Bruce Bagley, MD; Janet Leiker, RN, MPH, CPHQ

American Academy of Orthopaedic Surgeons: Bob Haralson, MD, MBA; Jill Hughes

American Association of Clinical Endocrinologists: Tammy L. Chaney

American College of Rheumatology: Amy Miller

The Endocrine Society: Janet Kreizman

Facilitators: Timothy F. Kresowik, MD; Rebecca A. Kresowik

American Medical Association: Karen S. Kmetik, PhD; Heidi Bossley, MSN, MBA

National Osteoporosis Foundation: Roberta Biegel

National Committee for Quality Assurance: Sarah Sampsel, MPH

The Joint Commission: Ann Watt, RN

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jun

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American Association of Clinical Endocrinologists, American College of Rheumatology, The Endocrine Society, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Osteoporosis physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2009 Nov. 18 p.

Source(s)

National Committee for Quality Assurance (NCQA). Osteoporosis: communication with the physician or other clinician managing on-going care post fracture for men and women aged 50 years and older. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Jun 5. 3 p.

Measure Availability

Source not available electronically.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on October 12, 2007. The information was verified by the measure developer on November 21, 2007.

This NQMC summary was retrofitted into the new template on June 8, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

Stewardship for this measure was transferred from the PCPI to the NCQA. NCQA informed NQMC that this measure was updated. This NQMC summary was updated by ECRI Institute on September 21, 2015. The information was verified by the measure developer on November 3, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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