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  • Measure Summary
  • NQMC:010347
  • Jun 2015
  • NQF-Endorsed Measure

Osteoporosis: percentage of women age 50 to 85 who suffered a fracture and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis.

National Committee for Quality Assurance (NCQA). Osteoporosis: osteoporosis management in women who had a fracture. 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.

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 women age 50 to 85 who suffered a fracture and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis.

Rationale

The intent of this measure is secondary prevention of fractures through the appropriate diagnosis and treatment of osteoporosis. Detecting osteoporosis and initiating treatment will help to prevent future fractures from occurring. Future fractures, especially in the older population, can cause significant health issues, decline in function, and, in some cases lead to mortality.

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

Appropriate follow-up care for a fracture in post-menopausal women includes either 1) bone mineral density testing to assess whether a patient has osteoporosis or 2) receiving pharmacologic therapy to treat osteoporosis. This measure is based on guidelines and evidence that patients at high risk of fracture, including a patients with a history of fragility fractures, should be screened for osteoporosis (U.S. Preventive Services Task Force [USPSTF], 2012; Nelson et al., 2010; Watts et al., 2010) and that patients who have a fragility fracture of the hip or spine should be provided with a treatment for osteoporosis (Watts et al., 2010; Crandall et al., 2012).

"The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors" (USPSTF, 2011).

All postmenopausal women with a history of fracture without major trauma should receive a bone mineral density test to test for osteoporosis (Watts et al., 2010). Patients who have a history of fracture of the hip or spine also need pharmacologic therapy to treat for osteoporosis (Watts et al., 2010; Cosman et al., 2014).

Evidence for Rationale

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

Crandall CJ, Newberry SJ, Gellad WG, Diamant A, Lim YM, Suttorp M, Motala A, Ewing B, Roth B, Timmer M, Shanman R, Shekelle PG. Treatment to prevent fractures in men and women with low bone density or osteoporosis: update of a 2007 report (Prepared by Southern California Evidence based Practice Center under Contract No. HHSA-290-2007-10062-I.). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 438 p. (Comparative effectiveness review; no. 53). 

National Committee for Quality Assurance (NCQA). Osteoporosis: osteoporosis management in women who had a fracture. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Jun 5. 3 p.

Nelson HD, Haney EM, Chou R, Dana T, Fu R, Bougatsos C. Screening for osteoporosis. Systematic review to update the 2002 U.S. Preventive Services Task Force Recommendation. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Jul.

U.S. Preventive Services Task Force (USPSTF). Final update summary: osteoporosis: screening. [internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2011 Jan [accessed 2015 Jul 01].

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; bone mineral density test; pharmacologic therapy

Denominator Description

Women who experienced a fracture, except fractures of the finger, toe, face or skull (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who received either a bone mineral density test or a prescription for a drug to treat osteoporosis after a fracture occurs (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

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Hospital Outpatient

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 50 to 85 years

Target Population Gender

Female (only)

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

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
Women 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 performing a central dual energy X-ray absorptiometry (DXA) measurement (e.g., had a DXA in the past two years, received osteoporosis medication or therapy in the past 12 months)
  • Documentation of patient reason(s) for not ordering or performing a central DXA measurement or not prescribing pharmacologic therapy for osteoporosis
  • Documentation of system reason(s) for not ordering or performing a central DXA measurement or not prescribing pharmacologic therapy for osteoporosis

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who received either a bone mineral density test or a prescription for a drug to treat osteoporosis after a fracture occurs

Note:

  • Pharmacologic Therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical order: bisphosphonates (alendronate, alendronate-cholecalciferol, calcium carbonate-risedronate, ibandronate, risedronate, zoledronic acid, calcitonin, teriparatide, denosumab, and raloxifene.
  • Prescribed: May include prescription given to the patient for treatment of osteoporosis (as listed above) at one or more encounters during the reporting period, or documentation that patient is already taking pharmacologic therapy for osteoporosis, as documented in the current medical list.
  • 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 #40: osteoporosis management in women who had a fracture.

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

Endorser

National Quality Forum

NQF Number

0053

Date of Endorsement

201 Dec 30

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: osteoporosis management in women who had a fracture. 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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