Get documents about "ABIM Osteoporosis PIM™Practice Improvement ModuleMeasures Catalogue - American Board of Internal Medicine
W
Description
This catalogue provides information related to the American Board of Internal Medicine’s Osteoporosis Practice Improvement Module®. It is written in language that addresses the physician who might choose to complete this module, and it details the specifics of the module. This PIM examines the care you provide to your patients by addressing key processes and outcomes related to osteoporosis. These are based primarily on guidelines from the American Association of Clinical Endocrinologists, the National Osteoporosis Foundation, the U.S. Preventive Services Task Force, and the World Health Organization http://www.abim.org/
Document Sample
ABIM Osteoporosis PIM™
Practice Improvement Module
Measures Catalogue
Osteoporosis PIM
Measures Catalogue
September 2010
TABLE OF CONTENTS
Introduction ............................................................................................................................................ 3
Processes of Care
History.................................................................................................................................................................... 5
Physical Examination........................................................................................................................................... 5
Diagnostic Testing................................................................................................................................................ 7
Counseling ............................................................................................................................................................ 7
Treatment............................................................................................................................................................... 9
Osteoporosis Measure Catalog September 2010 Page 2 of 9
Introduction
This catalogue provides information related to the American Board of Internal Medicine’s Osteoporosis Practice
Improvement Module®. It is written in language that addresses the physician who might choose to complete this module, and it
details the specifics of the module. Included is information regarding:
• Purpose and structuring of the module
• Patient inclusion criteria
• Detailed description of the measures
This PIM examines the care you provide to your patients by addressing key processes and outcomes related to osteoporosis. These are
based primarily on guidelines from the American Association of Clinical Endocrinologists, the National Osteoporosis Foundation, the
U.S. Preventive Services Task Force, and the World Health Organization.
The PIM is divided into three parts, with multiple sections in each part.
Part 1 -Performance Data
Provide baseline data about your practice's current performance by...
• Reviewing your charts
• Assessing your practice systems
The 21 chart review measures are summarized below. ABIM requires a minimum of 25 chart reviews. The practice systems
assessment comprises questions covering various aspects of practice structure and protocols.
Patients can be included in this module if all of the following are true:
1. They are between the ages of 18 and 110 (inclusive);
2. Management decisions regarding the diagnosis and treatment of osteoporosis are made primarily by providers in the
practice;
3. They have been patients in the practice for at least one year; AND
4. They have been seen by the practice within the past 12 months.
Osteoporosis Measure Catalog September 2010 Page 3 of 9
Types of Patients:
o Women age 65 and older
o Men age 70 and older
o Patients with osteopenia or prior low-impact fracture
o Patients on chronic oral or parenteral corticosteroid therapy
o Patients taking other medications associated with secondary osteoporosis
o Transplant recipients
o Women with a history of breast cancer
o Men with a history of prostate cancer
o Patients with other conditions associated with an increased risk for osteoporosis
o Patients with other risk factors for osteoporosis
Part 2 - Quality Improvement (QI) Plan
Develop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysis
will include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this quality
improvement (QI) cycle.
Part 3 - Remeasurement
Remeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect on
the process of developing and implementing a QI plan.
You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates this
educational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.
Osteoporosis Measure Catalog September 2010 Page 4 of 9
OSTEOPOROSIS - PROCESSES OF CARE
History
Measure Title Description Numerator Denominator Rationale
Smoking status Patients in the sample whose Number of patients in the sample Number of patients Cigarette smokers have increased
current smoking status was whose current smoking status in the sample catabolism of endogenous
documented was documented estrogen, and experience more
fractures.
Medical record Patients in the sample whose Number of patients in the sample Number of patients Weight-bearing exercise may slow
documents information status regarding participation in whose medical record indicated in the sample bone loss attributable to disuse in
about patient’s exercise a weight-bearing exercise whether or not patient elderly persons. In addition, regular
level program was documented participated in a weight-bearing exercise promotes mobility, agility,
exercise program and muscle strength, all of which
may help prevent falls.
Current level of alcohol Patients in the sample whose Number of patients in the sample Number of patients Good evidence has been found that
use current level of alcohol use was whose current level of alcohol in the sample screening regarding alcohol use can
documented use was documented accurately identify patients whose
levels or patterns of alcohol
consumption place them at risk for
increased morbidity and mortality.
Screen for falls risk Patients in the sample whose Number of patients in the sample Number of patients A prospective study of elderly,
evaluation screen for falls risk evaluation whose screen for falls risk in the sample ambulatory women identified a
was documented. evaluation was documented slower gait, difficulty in performing a
heel-to-toe walk and reduced visual
acuity as significantly predictive of
risk for subsequent hip fracture.
Physical Examination
Measure Title Description Numerator Denominator Rationale
Height Patients in the sample with Number of patients in the sample Number of patients Studies have shown that height loss
height documented who have height documented in the sample of 2 to 3 inches increases more
than fourfold the chances of women
having osteoporosis of the hip.
Odds of osteoporosis in the hip are
nearly 10 times greater in women
with 3 or more inches of height loss,
compared with women with less
than an inch of loss.
Osteoporosis Measure Catalog September 2010 Page 5 of 9
Physical Examination
Measure Title Description Numerator Denominator Rationale
Weight Patients in the sample with Number of patients in the sample Number of patients Epidemiological evidence shows
weight documented who have weight documented in the sample that obesity is correlated with
increased bone mass. A high-
quality meta-analysis showed that
low body weight (body mass index
20 to 25 kg/m2 or lower) and/or
weight loss (10% [compared with
the usual young or adult weight or
weight loss in recent years]) are
important risk factors for
osteoporosis in men age 70 and
older.
Height stability or loss Medical record documents Number of patients in the sample Number of patients Studies have shown that height loss
whether or not patient has lost with documentation that they in the sample of between 2 inches and 3 inches
one inch in height or more have or have not lost one inch in increases more than fourfold the
height or more chances of women having
osteoporosis of the hip. Odds of
osteoporosis in the hip are nearly
10 times greater in women with 3 or
more inches of height loss
compared to women with less than
an inch of loss.
Presence or absence of Medical record documents Number of patients in the sample Number of patients Older adults with osteoporosis are
kyphosis whether or not patient has whose medical record in the sample at greater risk of spinal fractures
acquired kyphosis documents whether or not that can contribute to kyphosis.
patient has acquired kyphosis
Osteoporosis Measure Catalog September 2010 Page 6 of 9
Diagnostic Testing
Measure Title Description Numerator Denominator Rationale
Bone mineral density Patients in the sample (excluding Number of patients in the sample Number of patients BMD testing is a vital component in
testing performed and those who refuse to consider any (excluding those who refuse to in the sample, the diagnosis and management of
results documented pharmacologic therapy) who consider any pharmacologic excluding those who osteoporosis. BMD has been shown
have had bone mineral density therapy) who have had bone refuse to consider to correlate with bone strength and
testing and result documented mineral density testing and result any pharmacologic is an excellent predictor of future
documented (Normal, therapy fracture risk.
Osteopenia, or Osteoporosis)
Vitamin D level Patients in the sample whose Number of patients in the sample Number of patients According to a large body of
vitamin D level has been whose vitamin D level has been in the sample literature, vitamin D had varying
documented documented effects on fracture prevention,
depending on dose, analogs, and
population. One meta-analysis
found that 700 to 800 IU daily was
necessary to reduce hip and
nonvertebral fractures.
Complete falls Patients in the sample who were Number of patients in the sample Number of patients Since the majority of osteoporosis-
evaluation reported as having a complete who were report as having a in the sample related fractures result from falls, it
falls evaluation performed history of two or more falls, or reported as having a is also important to evaluate risk
fall-related injury and had a history of two or factors for falling.
complete falls evaluation more falls, or fall-
performed related injury
Counseling
Measure Title Description Numerator Denominator Rationale
Estimated dietary Patients in the sample whose Number of patients in the sample Number of patients Lifelong adequate calcium intake is
calcium intake current estimated dietary calcium whose current estimated dietary in the sample necessary for the acquisition of
intake was reported as being calcium intake was reported as peak bone mass and subsequent
documented being documented maintenance of bone health.
Calcium Patients in the sample whose Number of patients in the sample Number of patients Calcium and vitamin D are essential
supplementation status medical record indicates whether with documentation of whether in the sample as adjunctive therapies to the more
or not they take calcium or not they take calcium potent antiresorptive therapies.
supplementation supplementation Calcium supplementation should be
prescribed whenever it is needed to
achieve the recommended daily
intake levels.
Osteoporosis Measure Catalog September 2010 Page 7 of 9
Counseling
Measure Title Description Numerator Denominator Rationale
Calcium intake Patients in the sample with Number of patients in the sample Number of patients Lifelong adequate calcium intake is
assessment assessment of adequacy of with assessment of adequacy of in the sample necessary for the acquisition of
calcium intake through diet calcium through diet and/or peak bone mass and subsequent
and/or supplementation calcium supplementation maintenance of bone health.
Calcium intake Patients in the sample with Number of patients in the sample Number of patients Adequate calcium intake is a
counseling documentation of receiving with documentation of receiving in the sample fundamental element of any
counseling about appropriate counseling about appropriate osteoporosis prevention or
calcium intake calcium intake treatment program. Patients should
be counseled specifically on the
importance of calcium, vitamin D
and exercise as part of any
treatment program for osteoporosis.
Vitamin D intake Patients in the sample with Number of patients in the sample Number of patients According to several studies, 40%-
assessment assessment of adequacy vitamin with assessment of adequacy of in the sample 100% of U.S. community-dwelling
D intake through diet, vitamin D intake either because seniors are vitamin D deficient.
supplementation and sun the patient uses supplementation
exposure or because an estimate of
dietary vitamin D intake has
been documented
Vitamin D counseling Patients in the sample with Number of patients in the sample Number of patients Patients should be counseled
documentation of receiving with documentation of receiving in the sample specifically on the importance of
counseling about vitamin D counseling about adequate calcium, vitamin D and exercise as
vitamin D part of any treatment program for
osteoporosis. Dietary instruction
should be given to the patient
and/or caregiver to ensure
adequate understanding of dietary
requirements.
Weight-bearing Patients in the sample with Number of patients in the sample Number of patients Multiple studies have demonstrated
exercise program documentation of receiving with documentation of receiving in the sample a beneficial effect on bone density
advice to start, increase, or advice to start, increase, or from impact and non-impact
maintain participation in a maintain participation in a exercise. Randomized clinical trials
weight-bearing exercise program weight-bearing exercise program have shown that exercise can
reduce falls by up to 25% in older
adults. Also, when combined with
adequate calcium intake, exercise
can have a moderating effect,
Osteoporosis Measure Catalog September 2010 Page 8 of 9
Counseling
Measure Title Description Numerator Denominator Rationale
slowing the loss of bone mass.
Smoking-cessation Patients in the sample who are Number of patients in this Number of patients A number of large randomized
support within past 12 smokers and who received sample who are smokers and for in this sample who clinical trials have demonstrated the
months smoking-cessation counseling or whom smoking-cessation are smokers efficacy and cost-effectiveness of
treatment during the 12-month counseling or treatment was smoking-cessation counseling in
period prior to the visit date, with documented during the 12- changing smoking behavior and
a three-month grace period month abstraction period or reducing tobacco use.
three months prior to the
abstraction period
Treatment
Measure Title Description Numerator Denominator Rationale
Pharmacologic therapy Patients in the sample with Number of patients in the sample Number of patients FDA-approved drug therapies are
osteopenia, osteoporosis, prior with osteopenia, osteoporosis, in this sample with effective, safe, and proven to
low-impact fracture, transplant, prior low-impact fracture, osteopenia, reduce the risk of fracture. Agents
or chronic steroid use, who were transplant, or chronic steroid osteoporosis, prior approved by the FDA for
reported as taking use, who were reported as low-impact fracture, osteoporosis prevention and/or
pharmacologic therapy taking pharmacologic therapy transplant, or chronic treatment include bisphosphonates,
steroid use salmon calcitonin, estrogen,
raloxifene, and teriparatide.
Calcium Patients in the sample who were Number of patients in the sample Number of patients A meta-analysis of controlled trials
supplementation reported as taking calcium who were reported as taking in the sample of the effects of calcium
supplementation calcium supplementation supplementation on bone density
and fractures in postmenopausal
women shows that calcium
supplementation had a small
positive effect on BMD, and there
was a trend toward reduction in
vertebral fractures.
© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction or
adaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.
Osteoporosis Measure Catalog September 2010 Page 9 of 9
Related docs
Other docs by ds.abimorg
All NQF-Endorsed or AQA-, NCQA-, or PCPI-Developed Measuresv - American Board of Internal Medicine
Views: 1 | Downloads: 0
ABIM Human Immunodeficiency Virus (HIV) PIM™ Practice Improvement ModuleM - American Board of Internal Medicineeasures Catalogue
Views: 3 | Downloads: 0
