Objective : To examine osteoporosis prevention and treatment among home health care (HHC) patients at risk for fragility fracture in a large, Midwestern integrated home health care system.
Methods : All patients who received HHC services in 2006 were identified. ICD-9 diagnosis codes and pharmaceutical data were examined between 1/1/04-12/31/05 to determine risk status (high vs. average) for fragility fracture. Patients with a documented diagnosis of osteoporosis, osteopenia, Vitamin D deficiency, previous fragility fracture, stroke or those taking a glucocorticoid were categorized as high risk. Pharmaceutical data (e.g., estrogen, bisphosphonates) were obtained during the same two-year period to determine treatment status. Descriptive statistics documented the proportion at high risk and treatment status. Inferential statistics tested differences in characteristics (age, gender, race, number of comorbidities) among high risk patients with and without treatment.
Results : 2798 patients were seen in HHC during 2006 and had utilization data available in 2004 and 2005. Of these, 754 were categorized as high risk and 2044 as average risk. Approximately one-third (34%) of high risk patients received osteoporosis medication compared to 4% of average risk (p<0.0001). We found no treatment differences based on age. Those with higher comorbidity profiles were less likely to receive treatment (p<0.0001).
Conclusion : Only 34% of home health care patients at high risk for fracture received adequate treatment. Patients with more comorbidities were least likely to receive treatment. Since these individuals are receiving medical and nursing care, an opportunity exists to develop a program to increase treatment rates for those at greatest risk.