Clinical decision support system for the management of osteoporosis compared to NOGG guidelines and an osteology specialist: a validation pilot study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download Although osteoporosis is an easily diagnosed and treatable condition, many individuals remain untreated. Clinical dec...

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Published in:BMC Medical Informatics and Decision Making
Main Authors: Gudmundsson, Haukur T, Hansen, Karen E, Halldorsson, Bjarni V, Ludviksson, Bjorn R, Gudbjornsson, Bjorn
Other Authors: 1 Department of Medicine, Landspitali - University Hospital, Reykjavik, Iceland. haukurtg@icloud.com. 2 Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA. 3 School of Science and Engineering, Reykjavik University, Reykjavik, Iceland. 4 Immunology and Centre for Rheumatology Research, Reykjavik, Iceland. 5 The Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 6 Landspitali - University Hospital, Reykjavik, Iceland.
Format: Article in Journal/Newspaper
Language:English
Published: BioMed Central 2019
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Online Access:http://hdl.handle.net/2336/620870
https://doi.org/10.1186/s12911-019-0749-4
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Summary:To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download Although osteoporosis is an easily diagnosed and treatable condition, many individuals remain untreated. Clinical decision support systems might increase appropriate treatment of osteoporosis. We designed the Osteoporosis Advisor (OPAD), a computerized tool to support physicians managing osteoporosis at the point-of-care. The present study compares the treatment recommendations provided by OPAD, an expert physician and the National Osteoporosis Guideline Group (NOGG). We performed a retrospective analysis of 259 patients attending the outpatient osteoporosis clinic at the University Hospital in Iceland. We entered each patient's data into the OPAD and recorded the OPAD diagnostic comments, 10-year risk of major osteoporotic fracture and treatment options. We compared OPAD recommendations to those given by the osteoporosis specialist, and to those of the NOGG. Risk estimates made by OPAD were highly correlated with those from FRAX (r = 0.99, 95% CI 0.99, 1.00 without femoral neck BMD; r = 0.98, 95% CI, 0.97, 0.99 with femoral neck BMD. Reassurance was recommended by the expert, NOGG and the OPAD in 68, 63 and 52% of cases, respectively. Likewise, intervention was recommended by the expert, NOGG, and the OPAD in 32, 37 and 48% of cases, respectively. The OPAD demonstrated moderate agreement with the physician (kappa 0.51, 95% CI 0.41, 0.61) and even higher agreement with NOGG (kappa 0.69, 95% CI 0.60, 0.77). Primary care physicians can use the OPAD to assess and treat patients' skeletal health. Recommendations given by OPAD are consistent with expert opinion and existing guidelines.