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Staff education and performance feedback only slightly improve fracture prevention among nursing home residents

Most nursing home residents have osteoporosis (loss of bone mass) and are susceptible to falls and fractures. Yet only one-third of these residents receive recommended fracture prevention therapies such as bisphosphonate medication and hip protectors. A new study found that nursing home staff education and performance feedback only slightly improved use of bis-phosphonate medication or hip protectors for residents diagnosed with osteoporosis or with a history of hip fracture. However, low staff participation in the quality improvement intervention may have tempered the results, suggest investigators at the University of Alabama Center for Education and Research on Therapeutics.

The researchers randomized 67 nursing homes to receive the intervention immediately or after the study was complete (control group). The intervention included educational modules on osteoporosis evaluation and treatment, staff performance audit and feedback, case-based teleconferences on osteoporosis quality improvement, an osteoporosis toolkit, and detailing of the clinical issues by osteoporosis opinion leaders.

The use of osteoporosis medication or hip protectors improved by 8 percent in the intervention and 0.6 percent in the control group, an insignificant difference. Although 35 percent of the residents fell within 90 days of the start of the study, and 20 percent had suffered a previous fracture, prescription of fracture-prevention therapies other than calcium and vitamin D remained low.

Osteoporosis guidelines themselves may not be optimally suited for frail nursing home residents, note the researchers. For example, nearly 25 percent of study residents had peptic ulcer disease, inflammation of the esophagus, or difficulty swallowing that would preclude their use of oral bisphosphonates. The study was supported in part by the Agency for Healthcare Research and Quality (HS10389).

See "Randomized trial to improve fracture prevention in nursing home residents," by Cathleen S. Colon-Emeric, M.D., Kenneth W. Lyles, M.D., Paul House, and others, in the October 2007 American Journal of Medicine 120(10), pp. 886-892.

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