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Kaiser Permanente’s Healthy Bones Program Results in Reduction in Hip Fractures

According to recent information from the National OsteoporosisFoundationand the Office of the Surgeon General, osteoporosis is a major medical problem. The disease currently affects 8million women and 2 million men in the United States. Kaiser Southern California has a fully integrated Healthy Bones Program in place at all eleven of its medical centers. Using its electronic medical records system is capable of tracking dual X-ray absorptiometry scans, fragility fractures, and the medications used to treat or prevent osteoporosis, Kaiser’s multidisciplinary team prevented 970 hip fractures in calendar year 2007 (2544 hip fractures were predicted and the actual number was 1574), a reduction of 38.1%.

Excerpts from The Journal of Bone and Joint Surgery article:
http://www.ejbjs.org/cgi/content/full/91/Supplement_6/79

“According to recent information from the National OsteoporosisFoundationand the Office of the Surgeon General, osteoporosis is a major medical problem. The disease currently affects 8million women and 2 million men in the United States. An additional 34 million Americans have low bone mass. Each year, an estimated1.5 million individuals in the United States experience a fragility fracture secondary to osteoporosis, resulting in an annual cost of 18 billion dollars. With the rapidly aging U.S. population, the problem of osteoporosis is now reaching epidemic proportions. There are 75 million baby boomers entering the stage in their lives when they are most at risk for osteoporosis. One-half of all women and one-third of all men will sustain a fragility fracture during their lifetime.

Knowledge That What the Orthopaedic Surgeon Does Improves Bone Health

The literature has shown that orthopaedic surgeons have not done enough to aggressively diagnose and treat osteoporosis. It is important for orthopaedic surgeons to know that an aggressive osteoporosis disease-management program can decrease the rate of osteoporosis-related hip fractures by 25% to 50%. One such program is described below.

Background of the Kaiser Southern California Healthy Bones Program

Kaiser Southern California (Kaiser SCAL) is a health-maintenance organization in Southern California that is made up of eleven medical centers with 3.2 million members. Kaiser SCAL has an electronic medical records system that is capable of tracking dual X-ray absorptiometry scans, fragility fractures, and the medications used to treat or prevent osteoporosis. Kaiser SCAL has a fully integrated Healthy Bones Program in place at all eleven of its medical centers. The Healthy Bones Program was established by having orthopaedic surgeons serve as champions in a large multidisciplinary team comprised of healthcare providers from the following disciplines: endocrinology, family practice, internal medicine, rheumatology.

Results

Since the SCAL Healthy Bones Program was adopted, we have seen our annual dual X-ray absorptiometry scan utilization rate rise from 21,557 per year in 2002 to 78,262 per year in 2007, a 263% increase. The annual dual X-ray absorptiometry scan utilization rate in men was 1549 in 2002, and it increased to 15,700 per year by 2007, a 914% increase. The annual number of patients receiving anti-osteoporosis medications rose from 33,208 per year in 2002 to 84,155 per year in 2007, a 153% increase. The annual number of men who received anti-osteoporosismedications in 2002 was 2663, and that number increased to 9310 a year by 2007, a 250% increase. There was a large variation in the reduction in hip fracture rates at the eleven SCAL medical centers during the study period. The reduction in hip fracture rate varied from 31.0% to 54.3%. The overall hip fracture rate reduction was 38.1%. That translated into preventing 970 hip fractures in calendar year 2007 (2544 hip fractures were predicted and the actual number was 1574).

Keywords: Osteoporosis, Kaiser Permanente Southern California, Healthy Bones, electronic medical records, orthopaedic, bone loss, hip fractures, bone loss, multidisciplinary team

FOR MORE INFORMATION:

Jean Sud
Senior Manager, Public Policy & Communications
Kaiser Permanente, The Permanente Federation
1 Kaiser Plaza
Oakland, CA 94612
tel. 510.271.6317
Jean.L.Sud@kp.org
www.kaiserpermanente.org

Breast Cancer Screening Outreach Program Uses Coordinated Teams and Health Information Technology

Kaiser Permanente has become a national leader in breast cancer screening, demonstrating the improved quality of care that results from coordinated health teams and electronic information sharing. Information technology is helping caregivers coordinate activities throughout the organization. Clinicians and staff are using these new and constantly improving IT tools to communicate and coordinate with each other between departments and with patients. These strategies made Kaiser Permanente’s Southern California region the national leader in breast cancer screening rates in 2008.


Excerpted from Kaiser Permanente case study:

“Kaiser Permanente has become a national leader in breast cancer screening, demonstrating the improved quality of care that results from coordinated health teams and electronic information sharing. Information technology is helping caregivers coordinate activities throughout the organization. Clinicians and staff are using these new and constantly improving IT tools to communicate and coordinate with each other between departments and with patients. These strategies made Kaiser Permanente’s Southern California region the national leader in breast cancer screening rates in 2008.

The Importance of Early Screening and Detection

Women have a 13.2 percent lifetime risk of being diagnosed with breast cancer. That risk increases to a 1-in-7 chance as women reach their 60s. Unfortunately, too many women delay mammography or are not screened at recommended intervals. Reasons for delay include making the time, avoidance of discomfort, lack of understanding, fear of diagnosis, body image/self-consciousness issues, mobility, and geographic issues. Because 96 percent of all early-stage breast cancers are curable, actions such as early screening, detection, and treatment can reduce the death rate by 20 – 50 percent.

Engaging the Patient: A Coordinated Approach with an Informed Personal Touch

Addressing these many challenges required identifying new ways to engage women in breast health. Using an electronic database, we sent out routine notification letters to women who were due or overdue for their mammography screening. Even with simultaneous educational and awareness campaigns, the multidisciplinary care teams found that more direct and personalized interventions were required to increase the number of women receiving mammograms.”

Link to full case study: http://xnet.kp.org/future/ahrstudy/032709bcancer.html

Keywords: breast cancer, care teams, care coordination, communication, electronic medical record, health information technology, integrated care, Kaiser Permanente, kp healthconnect, mammography, mammogram, patient support, population health, preventive care, treatment, radiology ,safety, Southern California, treatment, value

FOR MORE INFORMATION:

Jean Sud
Senior Manager, Public Policy & Communications
Kaiser Permanente, The Permanente Federation
1 Kaiser Plaza
Oakland, CA 94612
tel. 510.271.6317
Jean.L.Sud@kp.org
www.kaiserpermanente.org

Proactive Office Visit Program Significantly Improves Quality of Care

Kaiser Permanente’s Southern California region has increased the use of preventive cancer screenings and effectively encouraged improved maintenance of cholesterol by coordinating care across all who touch patient’s lives and integrating incentives and information technology.


Excerpted from Kaiser Permanente case study:
http://xnet.kp.org/future/ahrstudy/032709proactive.html

“Kaiser Permanente’s Southern California region has increased the use of preventive cancer screenings and effectively encouraged improved maintenance of cholesterol by coordinating care across all who touch patient’s lives and integrating incentives and information technology. The proactive office encounter program fosters cooperation among providers: Clinical care teams composed of doctors, nurses, medical assistants and other staff work together to identify opportunities to engage patients and provide support and encouragement for positive action across the continuum of health care services. In addition, front-line union employees are financially rewarded through a performance sharing program when quality care goals, many affected by these types of screenings and preventative measures, are achieved.

The Challenge: Increasing Use of Preventive Care

Individuals in the U.S., regardless of insurance status, receive only about 55 percent of recommended health care, according to a 2004 RAND Corporation study. From preventive health screenings to routine monitoring and maintenance of treatable chronic health conditions, U.S. citizens under-utilize available basic care services.

Recognizing the need to improve delivery of health prevention services, Kaiser Permanente’s Southern California region created the proactive office encounter program to identify and target patients with chronic medical conditions and encourage them to be active participants in their own care. The program uses all members of the clinical care team in a coordinated and collaborative effort to engage, encourage and support patient health. The information and tools provided have helped increase preventive screenings and improve treatment adherence.”

Keywords: breast cancer screening, care teams, communication, cervical cancer screening, cholesterol control, chronic care, collaborative care, colon cancer screening, disease management, electronic medical record, evidence-based medicine, health information technology, integrated care, Kaiser Permanente, kp healthconnect, preventive care, safety, Southern California, treatment, value

FOR MORE INFORMATION:

Jean Sud
Senior Manager, Public Policy & Communications
Kaiser Permanente, The Permanente Federation
1 Kaiser Plaza
Oakland, CA 94612
tel. 510.271.6317
Jean.L.Sud@kp.org
www.kaiserpermanente.org