Closing The Post Fracture Care Gap In Manitoba
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 4,264
- 试验地点
- 2
- 主要终点
- Rates of BMD testing and/or osteoporosis pharmacotherapy in the year post-fracture using the population-based provincial administrative health data repository.
研究概览
简要总结
The objective of this study is to evaluate a post-fracture intervention for improving osteoporosis care in older men and women who have suffered a fracture that may indicate the presence of osteoporosis. Although osteoporosis can be identified with a bone mineral density (BMD) test, most individuals with osteoporosis are not diagnosed until they fracture. Post-fracture care often "falls between the cracks" when there is a breakdown in communication between hospital and community, or between specialists and primary care physicians. Often physicians and patients fail to make the connection between an acute fracture and osteoporosis, or the value of secondary prevention strategies. If untreated, there is an extremely high rate of additional fractures after a first osteoporotic fracture. It follows that improving BMD testing and/or treatment in appropriately identified individuals is a necessary step in optimizing post-fracture patient care. Over the next three years we will be testing and optimizing a notification procedure to physicians and/or patients relying upon fracture events reported to the provincial health service (Manitoba Health).
详细描述
A major 'care gap' exists in the management of patients with fractures suggestive of osteoporosis. Currently, only a small minority of these individuals who are at high risk for recurrent fractures undergo evaluation for possible treatment. We propose to test and optimize a novel approach to address this question, relying upon fracture events reported to provincial health service (Manitoba Health) as a mechanism for osteoporosis case identification and enhancing post fracture care.
Phase 1 (one year duration): individuals meeting the fracture case definition will be randomized to usual care (no intervention), physician notification and physician/patient notification. The notification will provide a general recommendation for osteoporosis assessment. The use of appropriate post-fracture investigations and treatment will be prospectively evaluated.
Phase 2 (up to two years duration): the intervention will be refined and iteratively trialed for all individuals meeting the fracture case definition.
Phase 3: a recommendation for long term maintenance of the post-fracture intervention will be developed.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 50 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Women and men age 50 and older with one of the following fracture definitions:
- •Hip fracture (physician ICD-9-CM 820-821 plus a procedure code for site-specific fracture reduction or fixation, open or closed)
- •Spine fracture (physician ICD-9-CM code 805), or
- •Humerus fracture (physician ICD-9-CM code 812), or
- •Colles' fracture (physician ICD-9-CM code 813 plus a physician claim for site-specific fracture reduction or fixation, open or closed, or cast application).
排除标准
- •Age less than
- •Non-Manitoba residents, cancelled Manitoba Health coverage, death or discharge to a personal care home.
- •A fracture event in the previous 12 months meeting the study case definition (i.e., only a single notification per year is planned).
- •Hip or wrist fractures without a procedure tariff.
- •Current treatment with an osteoporosis medication.
- •BMD testing within the preceding 3 years.
研究组 & 干预措施
1 (physician-only)
Physician(s) connected with a fracture that meets study inclusion criteria.
干预措施: Information letters (Other)
2 (physician/patient)
Physician(s) and patient connected with a fracture that meets study inclusion criteria.
干预措施: Information letters (Other)
Control
Usual care.
结局指标
主要结局
Rates of BMD testing and/or osteoporosis pharmacotherapy in the year post-fracture using the population-based provincial administrative health data repository.
时间窗: 3 years (Phase 1 analysis at 1 year)
次要结局
- An evaluation of post-fracture BMD testing and treatment rates in the years prior to the Phase 1 will also be performed to document practice patterns before the intervention.(1 year)
- For individuals referred for BMD testing, an evaluation of treatment appropriateness will be performed based upon BMD results and 10-year fracture risk methods.(3 years (Phase 1 analysis at 1 year))
- Repeat fracture rates will be also studied as a secondary endpoint.(3 years (Phase 1 analysis at 1 year))
研究者
William D. Leslie
Professor of Medicine and Radiology
University of Manitoba