Table 3 List of QI’S
List of QI’S | EHR-extractability |
|---|---|
DIAGNOSIS | |
1) Percentage of patients with history of a fragility fracture* and/or a T-score of -2.5 or lower on 'dual energy X-ray absorptiometry' (DXA) in the lumbar spine (antero-posterior), femoral neck, hip or 1/3 radius who were diagnosed with osteoporosis | Adjustments EHR necessary |
SCREENING | |
2) Percentage of patients under the age of 50 with one or more clinical risk factor¥ who were screened for osteoporosis by calculating FRAX (Fracture Risk Assessment Tool) every 2 years | Adjustments EHR necessary |
3) Percentage of postmenopausal women or men ≥ 50 years of age with - one or more clinical risk factor¥ for fragility fracture or/and - current smoking or/and- age > 65 years who were screened for osteoporosis by calculating the FRAX score every 2 years | Adjustments EHR necessary |
4) The percentage of patients with risk factors for developing secondary osteoporosis i.e.: - Rheumatoid arthritis, Crohn’s disease, ulcerative colitis, - Hypercortisolaemia (Cushing’s syndrome), hyperthyroidism, hyperparathyroidism, hyperprolactinaemia, - Early menopause** - Male hypogonadism, diabetes mellitus type I and II, - Chronic liver disease, gastrointestinal resection or bypass, celiac disease, malabsorption, lactose intolerance, - Alcoholism, anorexia nervosa, calcium deficiency, vitamin D deficiency, - eGFR < 60 ml/ min/1.73 m2, - Glucocorticoids, aromatase inhibitors, gonadotropin-releasing hormone agonists, Tamoxifen, chemotherapy, - Paraplegia, quadriplegia, - Asthma, chronic obstructive pulmonary disease, - Parkinson’s disease, multiple sclerosis, stroke, who were screened for osteoporosis by calculating the FRAX score every 2 years | Adjustments EHR necessary |
TECHNICAL INVESTIGATIONS | |
5) The percentage of patients with osteoporosis in whom subsequent blood tests were investigated once after the diagnosis: - Complete formula - Creatinine - Serum calcium - Phosphate - 25-OH vitamin D - Total protein - Albumin - TSH - Alkaline phosphatases - Ferritin, Fe and transferrin | EHR-extractable at present |
6) The percentage of patients with - A history of fragility fracture* or/and - Two or more risk factors: one or more clinical risk factors¥, age > 65 years or active smoking; or/and - A FRAX score for primary fracture ≥ 5% or/and - Treatment with aromatase inhibitors, antiandrogens for 3 months or longer (both current, prior and cumulative use) who had a DXA | Adjustments EHR necessary |
LIFESTYLE MANAGEMENT | |
7) The percentage of patients with osteoporosis who were advised to stop smoking | EHR-extractable at present |
8) The percentage of patients with osteoporosis who were advised to limit alcohol use to ≤ 2 units per day | EHR-extractable at present |
9) The percentage of patients who either had a fracture or a fall ≥ 1/ year who were referred for physiotherapy (fall prevention and rehabilitation) | Adjustments EHR necessary |
10) The percentage of patients with osteoporosis who were advised to engage in physical activity | EHR-extractable at present |
TREATMENT | |
11) Percentage of patients with osteoporosis who take 800–1.000 IU vitamin D per day | EHR-extractable at present |
12) Percentage of patients > 50 years with vitamin D deficit < 30 ng AND a clinical risk factor¥ for osteoporosis or current smokers who take 800–1000 IU vitamin D per day | EHR-extractable at present |
13) Percentage of patients > 65 years with a clinical risk factor¥ for osteoporosis or current smokers who take 800–1000 IU vitamin D per day | EHR-extractable at present |
14) Percentage of patients with osteoporosis who have calcium intake of 1200 mg/day or ≥ 4 diary portions a day | Adjustments EHR necessary |
15) Percentage of postmenopausal women and patients over 50 years old who had a major osteoporotic fracture$ in the past 2 years receiving pharmacological osteoporosis treatment now or have received treatment in the past | Adjustments EHR necessary |
16) Percentage of patients with FRAX 10-year probability of major osteoporotic fracture$ ≥ 20% or a 10-year probability of a hip fracture of ≥ 3% or ≥ 5% for patients aged ≥ 70 years who receive pharmacological osteoporosis treatment | Adjustments EHR necessary |
17) Percentage of patients with T-scores ≤—2.5 at the lumbar spine, femoral neck or total hip region receiving pharmacological osteoporosis treatment | Adjustments EHR necessary |
18) Percentage of patients with osteoporosis with: - No fragility fracture* in the last 2 years or/and - T-score ≤ -2,5 and > -3.5 or/and - FRAX risk of major osteoporotic fracture$ ≥ 20% and < 30%, or hip fracture ≥ 3% and < 4.5% receiving oral bisphosphonates during 5 years as first line therapy if not contraindicated and well tolerated | Adjustments EHR necessary |
19) Percentage of osteoporosis patients with one or more of the following: -Barrett esophagus, -Esophageal abnormalities, -Gastric ulcers, -Gastric bypass, -Severe GERD, -Malabsorption -Chronic renal insufficiency eGFR < 35 ml/min who do not receive oral bisphosphonates | EHR-extractable at present |
20) Percentage of osteoporosis patients with - Gastrointestinal contra-indications and - eGFR ≥ 35 ml/min and - No fragility fracture* in the last 2 years and/or - T-score ≤ -2,5 and > -3.5 and/or - FRAX risk of major osteoporotic fracture$ ≥ 20% and < 30%, or hip fracture ≥ 3% and < 4.5% receiving intravenous bisphosphonates once a year for three years | Adjustments EHR necessary |
21) Percentage of osteoporosis patients with - eGFR < 35 ml/min and - No fragility fracture* in the last 2 years or/and - T-score ≤ -2,5 and > -3.5 or/and - FRAX risk of major osteoporotic fracture$ ≥ 20% and < 30%, or hip fracture ≥ 3% and < 4.5% receiving subcutaneous Denosumab every six months as first line treatment | Adjustments EHR necessary |
22) Percentage of osteoporosis patients treated with Zoledronate after a hip fracture | EHR-extractable at present |
23) Percentage of osteoporosis patients receiving Denosumab in whom their serum calcium levels were checked 2 weeks prior treatment during the first year of treatment | EHR-extractable at present |
24) Percentage of osteoporosis patients with eGFR < 35 ml/min receiving Denosumab in whom their serum calcium levels were checked 2 weeks prior and 2 weeks after treatment during the first year of treatment | EHR-extractable at present |
FOLLOW-UP | |
25) Percentage of osteoporosis patients who had annual check-ups with measurements of height and weight, control of compliance, checking for fractures or fall incidents and assessment of risk factors | Adjustments EHR necessary |
26) Percentage of osteoporosis patients taking bisphosphonates who had annual check of creatinine, calcium and vitamin D | EHR-extractable at present |
27) Percentage of osteoporosis patients taking zoledronate for 3 years or alendronate for 5 years with a risk factor i.e - T score after 3 years of treatment < -2.5 or/and - age > 75 years or/and - history of hip or vertebral fracture or/and - one or more fractures due to minimal trauma during treatment or/and - current treatment with oral glucocorticoids ≥ 5 mg prednisolone daily or equivalent in whom zoledronate is continued for an additional 3 or 5 years respectively | Adjustments EHR necessary |
28) Percentage of osteoporosis patients with T- score higher than -2.5 after taking zoledronate for 3 years/ alendronate for 5 years in which treatment is discontinued | Adjustments EHR necessary |
29) Percentage of osteoporosis patients in whom bisphosphonates are discontinued after 3–5 years who receive a control BMD after 2 years or in case of new fragility fracture* | Adjustments EHR necessary |
REFERRAL | |
30) Percentage of patients < 50 years with a fragility fracture* who are referred to a specialist | Adjustments EHR necessary |
31) Percentage of osteoporosis patients with ≥ 2 new fractures despite > 1 year of treatment with bisphosphonates and good compliance who are referred to a specialist | Adjustments EHR necessary |
32) Percentage of osteoporosis patients with GFR < 15 ml/min/1.73 m2 who are referred to a specialist | EHR-extractable at present |
33) Percentage of pre-menopausal women and men < 50 years with a T score -2,5 who are referred to a specialist | Adjustments EHR necessary |
34) Percentage of osteoporosis patients with: - a fragility fracture* in the last 2 years or/and - multiple (≥ 2) fragility fractures* or/and - a T-score < -3.5 or/and - FRAX risk of major osteoporotic fracture$ > 30%, hip fracture > 4.5% who are referred to a specialist | Adjustments EHR necessary |