Geisinger rheumatologists redesign osteoporosis, rheumatoid arthritis care

Nov 19 2007

With the nation collectively spending about $18 billion per year on osteoporosis related bone fractures, Geisinger researchers found that streamlining the ordering process for osteoporosis bone density scans quadrupled the number of patients who received the exam.

An estimated 10 million Americans suffer from osteoporosis. Like most providers, Geisinger Health System measures the mineral content in the bones of patients who are at high-risk for osteoporosis through DXA scans.

Follow-up exams are usually needed to assess how the disease has progressed. Geisinger's rheumatology department removed some of the steps involved, shifted the responsibility of ordering the exam from the patient's primary care provider to the rheumatology staff and made greater use of Geisinger's $80 million Electronic Health Record.

Before the change, 18% of patients received the test. After the test, 88% received the scan.

“A broken bone from osteoporosis can be excruciating and hard to recover from,” said Eric Newman, MD, Geisinger's Rheumatology Director. “Testing for osteoporosis is the first step in preventing these breaks.”

Results of the study were presented at the American College of Rheumatology's annual meeting in Boston recently. Geisinger had four presentations at the meeting, the most ever for the department.

The other work included:

• Plenary Presentation - The first in-depth study of new care recommendations that were issued by the American College of Rheumatology. Geisinger examined the records of over 1,000 patients with rheumatoid arthritis to see how many patients received certain suggested care benchmarks such as joint exams and use of medication.

Among the study's key findings was that 94% of the patients received disease modifying antirheumatic drugs, which ease pain, reduce inflammation and reduce or prevent joint damage. This was far higher than anticipated, Newman noted.

While more than 3,000 study abstracts were submitted for the meeting, this was one of just 14 studies that were accepted as plenary presentations.

• The third study found that treatment decisions in patients with rheumatoid arthritis are altered if doctors have all of a patient's data immediately in front of them in several summarizing charts, as opposed to having the information scattered throughout many pages in the Electronic Health Record and in paper files.
• The fourth study examined how fellowship training for rheumatologists has improved significantly by adding a specific osteoporosis training curriculum.

“It was an outstanding year for us,” Newman said. “These studies reflect our staff's talent and commitment to delivering the best care to our patients.”