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Abstract

Improving Bone Health: Get the DEXA scan done! 

Gjonaj,S., Sung,J., Collins,T.,D’Amico,A.,Curcio,G.,Suderio-Tirone,E.,Foggit,A., Stack,G.,Boston Children’s Health Physicians, Valhalla,NY, Vassar Brothers Med Ctr, Poughkeepsie,NY, MidHudson Regional Hosp, Poughkeepsie,NY

 

Background: Our affiliate CF Center in rural New York survived the continuing impact from the COVID pandemic. Despite the myriad of obstacles, our QI team remained committed to improving the care provided by our small center. With the advent of modulators, life expectancy for patients with CF has increased, which could lead to age-related diseases such as CF related bone disease (CFBD). In young adults with CF, 23.5% are estimated to have osteoporosis. Additionally, 14% of all patients with CF are estimated to have vertebral fractures(1).Review of our center 2021 specific report showed that we were remiss in completing Dual Energy X-Ray Absorptiometry (DEXA) scans to evaluate bone health in accordance with CFF Care Guidelines. This propelled us to launch a nutrition QI initiative.

 

Method: Our global aim was to improve the bone health of our patients. By doing this we will achieve: better understanding of our patient’s bone health, identify gaps in care for intervention(s), improve DEXA scan ordering and compliance, and improve patient education, which will ultimately lead to improved overall bone health of our patients and to prevent pathological fractures. Our specific aim was to increase the percentage of physicians ordering a DEXA scan for eligible patients from 0% to 100%, and to increase the percentage of those patients completing the scan from 0% to 40%. After assessing the barriers, we started the first PDSA cycle to identify appropriate patients. Followed by multiple PDSA cycles, we educated our patients regarding the need for the scan using our center’s website, newsletters, annual checklist, handouts, and physician and dietitian visits to disseminate the information. Prescriptions for the scans were given at physician visits and via mail on a quarterly basis. Our measure was a Tick & Tally of the number of DEXA scans ordered and the number of scans completed in 2022.  

 

Results: We achieved 88% of eligible patients having the DEXA scan ordered by physicians and 13% of eligible patients completing the scan (Table 1). 

Table 1: DEXA Scan QI Results 

Discussion: As the life expectancy of our patients increases, so does the risk of CFBD. People with CF have an increased risk for fractures and low bone mineral density related to poor nutritional status, chronic lung disease, malabsorption of fat-soluble vitamins, lack of activity, and corticosteroid use (2). We based our DEXA scan protocol on the CFF Guidelines for care. Following the QI process helped us improve the ordering and obtaining of DEXA scans on eligible patients at our center. Although we did not reach our goals, we improved awareness and assessment of bone health in our patients, and now have a definitive process in place to monitor for CFBD. We are now continuing this QI initiative with SDSA cycles towards achieving our specific aims. We are confident that with continued monitoring and updating using the QI process, that we will achieve our specific aims over time.

 

References:

  1. JavierR, Jacquot J.Bone disease in Cystic Fibrosis:what’s new?Joint Bone Spine.2011 Oct;78(5):445-50. doi: 10.1016/j.jbspin.2010.11.015. Epub 2011 Jan 12.https://pubmed.ncbi.nlm.nih.gov/21233000/

  2. Stalvey MS, Clines GA. Cystic fibrosis-related bone disease:insights into a growing problem.Curr Opin Endocrinol Diabetes Obes. 2013 Dec; 20(6): 547–552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061713/

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