St. Michael’s Hospital provides compassionate care to all who enter its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael’s Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto. The Mobility Program Clinical Research Unit, part of the Keenan Research Centre and Li Ka Shing Knowledge Institute, has conducted research in osteoporosis care after fragility fracture, including being one of the first fracture clinic coordinator-based models of care in the world.
Our role in the Osteoporosis Strategy
The role of the Mobility Program Clinical Research Unit is to evaluate the Osteoporosis (OP) Strategy Fracture Clinic Screening Program for both quality assurance and research purposes to provide insight into the data collected by the Strategy. Principal Investigators, Dr. Dorcas Beaton and Dr. Earl Bogoch, of the Mobility Program Clinical Research Unit, Keenan Research Centre, Li Ka Shing Knowledge Institute at St Michael's Hospital (Dr. Bogoch is also in the Department of Surgery at St. Michael’s Hospital) have assembled an interdisciplinary group of researchers, clinical epidemiologists and analysts as part of this evaluation team.
Our broad group of collaborators works with us to think through the evaluation of the data, that is
collected by the Osteoporosis Screening Coordinators (OSCs) as part of the OP Strategy Fracture Clinic
Screening Program, and help us to examine the impact of the Program on rates of bone mineral density (BMD)
testing and treatment for OP. We also examine predictors of those outcomes, or outcomes relating to specific
types of fractures. Along with the Applied Health Research Centre (AHRC), which is part of the Keenan
Research Centre at the Li Ka Shing Knowledge Institute of St. Michael’s, this group of collaborators includes
people working in other areas of the OP Strategy, and
researchers that can help expand our methods and reach in terms of Knowledge Transfer. We produce feedback to
the OSCs, ORMEW, and the MOHLTC, as well as academic papers and presentations, on a continuing basis to share
knowledge about what we are learning from this evaluation in regards to improving OP treatment and ultimately
reducing the rate of re-fracture in those who have had a fragility fracture.
We believe the close relationship between our evaluation team, Osteoporosis Canada, the MOHLTC, and the frontline OSCs, is an ideal situation for improving the rates of OP testing and care in those persons managed at busy orthopaedic fracture clinics.
Key Strategy Activities
Post-fracture care and management
Post-fracture care and management:
Key activities:
The results of our evaluation of the Osteoporosis Strategy Fracture Clinic Screening Program informs two
streams of work:
- On a quarterly basis, we provide detailed analyses and audits of practice to the MOHLTC and to OSCs, including through inservices at OSC meetings.
- The OSCs seek consent for the research use of this data on a regular basis and the responses from these patients are used to inform research projects often presented at scientific meetings or published in peer-reviewed journals, as well as being integrated into the program itself.
Such research includes understanding patients’ pathway to BMD testing and treatment after a fragility fracture through qualitative research with focus groups and quantitative analyses. We also identify means for interventions to increase BMD testing and OP treatment initiation through:
- developing messaging for Orthopaedic surgeons to use in the clinics
- investigating the use of health behaviour change models
- qualitative work with focus groups examining those who are adherent with OP treatment medication
Further, based on our findings, we develop and modify data to be captured for the average 400 per month of patients who consent to research use of their data, at both screening and at follow-up. This facilitates our ability to improve the specificity of the data being collected and analyzed, as well as develop drop-in modules to answer specific questions. We now have 8,500 consenting patients’ data to link with provincial databases, through the Institute of Clinical Evaluative Sciences (ICES), which allow us to follow-up on bone health, refracture, BMD testing and OP care.
We also collaborate with Osteoporosis Canada to improve the OP Strategy Fracture Clinic Screening Program,
evaluate the impact of the improvements recommended based on our research findings, and address any specific
issues arising from the data or its collection.
Available resources and programs:
• Researching and developing a resource for patients to navigate the OP care pathway with an education and
self management tool
• Published manuscripts (see list below)
J. Sale, D. Beaton, J. Posen, V. Elliot-Gibson, E. Bogoch. Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporosis International 2011 Jul;22(7):2067-82.
Sujic R, Gignac M, Cockerill R, Beaton D. A review of patient-centered post-fracture osteoporosis interventions in the context of health behaviour change theories. Osteoporosis International. 2011 Aug;22(8):2213-24.
Sale J, Beaton D, Frankel L, Elliot-Gibson V, Bogoch E. The BMD muddle:
Understanding the disconnect between bone densitometry results and perception of bone health. Journal of
Clinical Densitometry 2010; 13(4):370-378.
Contact the authours for copies of poster/abstract/updates
Long-term outcomes:
- To facilitate the improvement of BMD testing and OP medication initiation and persistence rates in fracture clinics across Ontario for those at risk for future OP fractures
- To understand the patient and health care system factors that predict BMD testing, OP treatment initiation, and refractures
- To answer additional research questions that will help bridge the knowledge gap
- To make our work known and used in the osteoporosis care field
Main contacts for this project at St. Michael’s:
Rebeka Sujic, Research Coordinator – sujicr@smh.ca
Dr. Dorcas Beaton, Principal Investigator – beatond@smh.ca
Links
Contact Information
St. Michael's Hospital
30 Bond Street
Toronto, Ontario
M5B 1W8, Canada
416-360-4000
Telephone: 416-360-4000
Fax: (416) 696-2673
Email:Electronic Inquiry Form
Web: www.stmichaelshospital.com
