Randomized trial to improve fracture prevention in nursing home residents
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Authors
Colon-Emeric, Cathleen S.Lyles, Kenneth W.
House, Paul
Levine, Deborah A.
Schenck, Anna P.
Allison, Jeroan J.
Gorospe, Joel
Fermazin, Mary
Oliver, Kristi
Curtis, Jeffrey R.
Weissman, Norman W.
Xie, Aiyuan
Saag, Kenneth G.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2007-10-02Keywords
AgedAged, 80 and over
Arizona
Female
Fractures, Bone
Fractures, Spontaneous
*Homes for the Aged
Humans
Male
Middle Aged
Multivariate Analysis
North Carolina
*Nursing Homes
Odds Ratio
Osteoporosis
Outcome and Process Assessment (Health Care)
Quality Assurance, Health Care
Single-Blind Method
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Interventions to improve the fracture prevention in nursing homes are needed. METHODS: Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n=67) with > or =10 residents with a diagnosis of osteoporosis or recent hip fracture (n=606) were randomized to receive an early or delayed intervention consisting of audit and feedback, educational modules, teleconferences, and academic detailing. Medical record abstraction and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period. Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering. RESULTS: No significant improvements were observed in any of the quality indicators. The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0% in the intervention group and 0.6% in the control group, but the difference was not statistically significant (P=.72). Participation in the intervention activities was low, but completion of the educational module (odds ratio [OR] 4.8, 95% confidence interval [CI], 1.9-12.0) and direct physician contact by an academic detailer (OR 4.5, 95% CI, 1.1-18.2) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models. CONCLUSIONS: Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting, although results may have been tempered by low participation in the intervention activities.Source
Am J Med. 2007 Oct;120(10):886-92. Link to article on publisher's siteDOI
10.1016/j.amjmed.2007.04.020Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47686PubMed ID
17904460Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.amjmed.2007.04.020