A schema for effective osteoporosis management - Outcomes of the Geisinger Health System Osteoporosis Program

A disconnection exists between our understanding of osteoporosis diagnosis/treatment and our ability to provide optimal bone healthcare in an organized fashion. This disconnection results, in part, from problems in inertia (moving forward with the attitude that osteoporosis is a disease worthy of management), direction (focusing on the ultimate goal of osteoporosis diagnosis and management, i.e. reduction in fracture), and flow (making it easy to do the right thing, i.e. taking the best available science, mixing it with expert opinion, and developing a program that allows all of the participants [physicians, allied healthcare providers, patients, insurers] to play a role). The Geisinger Osteoporosis Program, developed by the Geisinger Clinic of the Geisinger Health System in Danville, Pennsylvania, USA, combines elements of healthcare provider education, patient empowerment, and access to bone density testing and outcomes assessment to achieve the outcomes of fracture reduction in a cost-effective fashion. The healthcare provider education component includes guidelines that are data driven yet easy to navigate in an electronic milieu, combined with numerous educational opportunities. The patient empowerment component includes a 'train the trainer' process, whereby allied healthcare providers were taught to teach people in the community about improving their bone health and seeking osteoporosis testing where appropriate. The bone density testing component combines peripheral technology (heel ultrasound) with central gold-standard technology (dual energy x-ray absorptiometry [DXA] of the hip and spine) to provide access to technology for rural patients. A mobile DXA unit provides central DXA scanning at the convenience of the primary care physician's office. Outcome measures from this program show increases in osteoporosis diagnosis, bone density testing, and prescription medication usage. A significant decrease in hip fracture was demonstrated, along with a reduction in costs based on a cost predictive model over a 5-year period. The Geisinger program has attempted to overcome some of the problems surrounding inertia, direction and flow in the management of osteoporosis by providing the following: clinical care pathways/guidelines that are simple, specific to patients and focus on care; consistent and integrative reports of bone density; getting primary care physicians engaged in the program; and making bone density testing as well as resources and expertise readily available. Using the Geisinger program as an example and applying it to the proper group of individuals, while having an investment in time and a commitment to improvement, physicians can help to move patients forward in maintaining healthy bones.