Background/Purpose: Osteoporosis is a silent disease characterized by low bone mass and deterioration of bone quality, affecting 25% of women.1 The United States Preventive Services Task Force (USPSTF) recommends screening women above 65 years old using dual energy x-ray absorptiometry (DEXA) scan.2 Screening can help identify patients who are at increased risk of osteoporosis and help reduce osteoporotic fractures. Despite universal guidelines and high prevalence, osteoporosis screening remains low in the primary care setting. The primary goal is to raise awareness for resident physicians and patients to improve screening rates for women aged 65-80 at Ryan Chelsea Clinton (RCC) clinic.

Methods: Our project was conducted at the RCC clinic, a federally qualified health center in New York City which also serves as a primary care training site. Through retrospective chart review, we obtained a baseline of 659 women who met USPSTF criteria for osteoporosis screening from February 2020 to February 2021. To better understand low screening rates including clinician and patient related factors, we conducted an online survey to resident physicians. We assessed baseline awareness of osteoporosis screening and barriers. 67.5% of resident physicians attributed insufficient encounter time as a major barrier to screening while 35% identified lack of knowledge of screening goals. Given these results, our primary intervention was to improve DEXA screening rates by 20% from baseline in a ten month period from April 2021 to February 2022 in female patients aged 65-80 years old. Plan-Do-Study-Act (PDSA) phase 1 was trifold: focusing on resident physician education, streamlining electronic medical record (EMR) ordering of the DEXA scan, and direct patient outreach. An informational sheet was created to guide osteoporosis education discussions with patients including risk factors, testing indications and prevention strategies. Workflow posters outlining ICD-10 coding for osteoporosis screening encounters and appropriate DEXA scan orders were distributed in the clinic. Through direct patient outreach, we called female patients aged 65-80 years old who visited the RCC clinic during the intervention period but did not have a completed DEXA to educate and discuss overdue osteoporosis screening.

Results: The baseline osteoporosis screening rate at RCC clinic from February 2020 to February 2021 was 37.8% with 249 completed DEXA scans. Following the implementation of our intervention from April 2021 to February 2022, the screening rates improved to 43.4%.

Conclusion: Introduction of this resident driven initiative led to increased osteoporosis screening with completed DEXA scans. There was a 5.6% increase in screening and a total of 14.8% increase from the baseline screening rate. Although we did not reach our aim of 20% improvement from baseline within this first PDSA cycle, there is a positive upward trend in rates. A dedicated educational approach to both patients and physicians is imperative to the diagnosis and management for early stages of low bone mass. Continued efforts can be focused on interventions addressing patient barriers to testing and streamlined criteria alerts for appropriate patients within our electronic medical record.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/building-stronger-bones-optimizing-osteoporosis-screening-at-a-primary-care-clinic/