Background/Purpose: The Center of Excellence (COE) in Musculoskeletal (MSK) Care and Education was established at the Salt Lake City Veterans Affairs Medical Center (SLCVAMC) in 2012. A major element of the COE is the MSK Week, an interprofessional, multidisciplinary, multilevel program for students and postgraduate trainees affiliated with the University of Utah. Objectives included increasing osteoporosis awareness among learners and improving access to appropriate screening and treatment for Veterans. We evaluated the impact of the MSK Week on internal medicine (IM) residents’ recognition and treatment of osteoporosis during their VA-based continuity clinic experience before and after training.

Methods: We conducted a retrospective cohort study of patients ages 50+ enrolled at SLCVAMC from July 1, 2013 to May 31, 2014. We used time-dependent multivariable Cox proportional hazard models evaluating the impact of the MSK Week on 5 osteoporosis-related outcomes: (1) completion of 25-hydroxyvitamin D measurement, (2) completion of dual energy x-ray absorptiometry (DXA), (3) diagnosis of osteopenia, (4) diagnosis of osteoporosis, and (5) initiation of osteoporosis medications. Multivariable models adjusted for confounders including age, sex, alcohol and tobacco use, diabetes, fractures, hyperparathyroidism, vitamin D deficiency, renal disease, and medications

Results:  We identified 26 IM trainees (PGY1) who completed the MSK Week in 7 groups. In our cohort of 43,678 veterans, 1,154 encountered a trainee who had completed the MSK Week (thus “exposed” to the training) and 42,524 patients who did not. Patients encountering a trained provider were more likely to have each outcome, with strongest effect in diagnosis of osteoporosis (RR = 7.1, 95% CI: 4.4, 11.2) and completion of DXA (RR = 4.4, 95% CI: 3.0, 6.1). In the univariate analyses, training was associated with increases in all outcomes, with HRs (95% CI) ranging from 7.0 (3.8-12.8) for osteoporosis diagnosis to 1.5 (1.3-1.8) for vitamin D measurement; p < 0.0001 for all. Adjusting for confounders, the effect of the MSK Education Week was significant for osteoporosis diagnosis (HR = 3.9, 95% CI: 2.1, 7.3), medication therapy (HR = 2.9, 95% CI: 2.0, 4.1), and evaluation with DXA (HR = 1.8, 95% CI: 1.1, 2.9).

Conclusion: Participation in the MSK Education Week was associated with improved access to appropriate care for Veterans, with increases in the rates of residents’ use of screening DXA, diagnosis, and treatment of osteoporosis following training. Next steps will include evaluation of the impact of the MSK Education Week on long-term osteoporosis outcomes, including rates of fragility fracture.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-a-musculoskeletal-training-program-on-residents-evaluation-diagnosis-and-treatment-of-osteoporosis/