Improving bone mineral density screening in patients with inflammatory bowel disease: a quality improvement report

The prevalence of osteopenia and osteoporosis in patients with inflammatory bowel disease (IBD) is estimated between 17% and 41%, partly due to repeat courses of glucocorticoids which enhance the risk for bone disease. Multiple gastroenterological and endocrine societies have established guidelines for bone mineral density (BMD) screening in patients with IBD, with estimates suggesting providers vary in their adherence. We aimed to improve the rate of BMD screening in patients with IBD in a large academic outpatient practice. Using the Plan-Do-Study-Act (PDSA) model, we first conducted a retrospective review and determined that only 10.8% of patients with IBD in our practice were adequately undergoing BMD screening. Over the course of five PDSA cycles, we conducted three interventions focusing on education and provider reminders. Through an informative lecture, a flyer and an electronic medical record-based prompt, we were able to increase our rate of BMD screening to 81.8%. Current rates of BMD screening in patients with IBD are not adequate. We demonstrate a simple quality improvement initiative that successfully improved our adherence to standards of practice.