Identification and validation of vertebral compression fractures using administrative claims data.

INTRODUCTION: Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture. Administrative claims data might be useful to identify VCFs, but this approach to case finding has received limited evaluation. METHODS: Using the administrative claims databases of a large regional US health care organization, we identified adults with a claim with a VCF diagnosis code from January 2003 to June 2004 and excluded persons with malignancy. We examined the positive predictive values (PPV) of several claims algorithms to correctly identify any confirmed (prevalent or incident) VCF, and separately, incident VCFs. RESULTS: A total of 259 persons were identified with a VCF suspected based on their administrative claims data. A claims algorithm that required a VCF diagnosis on any claim had a PPV to identify any confirmed VCF of 87% (95% confidence interval (CI), 82-91%). The PPV of this algorithm to identify a confirmed incident VCF was 46% (95% CI, 37-54%). An algorithm that required a spine imaging test followed by a physician visit with a VCF code within 10 days, or a hospitalization with a primary diagnosis code, had higher PPVs (PPV = 93%; 95% CI, 87-98% for any confirmed VCF; PPV = 61%; 95% CI, 49-74% for incident VCFs). CONCLUSIONS: A simple case finding approach to identify VCFs using administrative claims data can identify prevalent VCFs with high accuracy but misclassified more than half of incident VCFs. A more complex claims algorithm may be used but still will result in some misclassification of incident VCFs.

Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users: a prospective randomized trial.

BACKGROUND: In light of widespread undertreatment for glucocorticoid-induced osteoporosis (GIOP), we designed a group randomized controlled trial to increase bone mineral density (BMD) testing and osteoporosis medication prescribing among patients receiving long-term glucocorticoid therapy. METHODS: Using administrative databases of a large US health plan, we identified physicians who prescribed long-term glucocorticoid therapy to at least 3 patients. One hundred fifty-three participating physicians were randomized to receive a 3-module Web-based GIOP intervention or control course. Intervention modules focused on GIOP management and incorporated case-based continuing medical education and personalized audit and feedback of GIOP management compared with that of the top 10% of study physicians. In the year following the intervention, we compared rates of BMD testing and osteoporosis medication prescribing between intervention and control physicians. RESULTS: Following the intervention, intent-to-treat analyses showed that 78 intervention physicians (472 patients) vs 75 control physicians (477 patients) had similar rates of BMD testing (19% vs 21%, P = .48; rate difference, -2%; 95% confidence interval [CI], -8% to 4%) and osteoporosis medication prescribing (32% vs 29%, P = .34; rate difference, 3%; 95% CI, -3% to 9%). Among 45 physicians completing all modules (343 patients), intervention physicians had numerically but not significantly higher rates of BMD testing (26% vs 16%, P =.04; rate difference, 10%; 95% CI, 1%-20%) and bisphosphonate prescribing (24% vs 17%, P =.09; rate difference, 7%; 95% CI, -1% to 16%) or met a combined end point of BMD testing or osteoporosis medication prescribing (54% vs 44%, P =.07; rate difference, 10%; 95% CI, -1% to 21%) compared with control physicians. CONCLUSIONS: In the main analysis, a Web-based intervention incorporating performance audit and feedback and case-based continuing medical education had no significant effect on the quality of osteoporosis care. However, dose-response trends showed that physicians with greater exposure to the intervention had higher rates of GIOP management. New cost-effective modalities are needed to improve the quality of osteoporosis care.