Androgen Deprivation Therapy for Prostate Cancer: Specialty Clinic Collaboration and the Electronic Medical Record Can Improve Bone Health Monitoring

Introduction:Patients with prostate cancer on androgen deprivation therapy are at increased risk for iatrogenic osteoporosis, minimal trauma fractures and reduced bone density. We created a high risk osteoporosis clinic to manage patients at risk for these complications. A quality improvement initiative involving a best practice advisory and provider education program was implemented to enhance care of patients with prostate cancer.Methods:Fishbone diagrams were constructed to reveal causes of suboptimal bone health management. A best practice advisory was created for gonadotropin-releasing hormone agonist orders in the Epic electronic medical record to encourage referrals to the high risk osteoporosis clinic. Discussions were held with urology clinic staff regarding fracture risk. Referral rates were assessed via periodic chart reviews.Results:Baseline referral rate to the high risk osteoporosis clinic was 4%. Final review indicated that 113 patients with prostate cancer were seen in the urology clinic from March 2017 to April 2018, of whom 67 were referred to the high risk osteoporosis clinic. At the end of the study period the referral rate had increased to 59%. Among the 113 patients 32 received antiresorptive therapy, 75% of whom had been referred to the high risk osteoporosis clinic. Of 67 patients referred to the clinic 48 had dual energy x-ray absorptiometry completed or pending and 50 had vitamin D levels obtained or pending. Of 46 patients not referred to the clinic 7 had dual energy x-ray absorptiometry completed and 3 had vitamin D levels obtained or pending.Conclusions:Use of a best practice advisory and urology nursing staff education program increased high risk osteoporosis clinic referrals. A higher proportion of patients referred to the clinic had bone health monitored compared to patients without this referral.