Development of an integrated-care delivery model for post-fracture care in Ontario, Canada
- S. B. JaglalAffiliated withDepartment of Physical Therapy, University of Toronto Email author
- , C. CameronAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
- , G. A. HawkerAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
- , J. CarrollAffiliated withRay D. Wolfe Department of Family Medicine, Mount Sinai Hospital
- , L. JaakkimainenAffiliated withSunnybrook & Women’s College Health Sciences Centre
- , S. M. CadaretteAffiliated withOsteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre
- , E. R. BogochAffiliated withSt. Michael’s Hospital
- , H. KrederAffiliated withSunnybrook & Women’s College Health Sciences Centre
- , D. DavisAffiliated withContinuing Medical Education, University of Toronto
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The purpose of this study was to develop an integrated-care model for patients at highest risk for osteoporosis, those with a low-trauma fracture. Specific objectives were to describe the current processes and patterns of post-fracture care in hospitals in Ontario; to examine health-care professional and patient awareness of osteoporosis and the roles and responsibilities of various organizations and health care professionals; and to identify barriers and facilitators and obtain feedback on the model.
In 2002, questionnaires were completed for 178 eligible hospitals.
Only 65% of hospitals inform primary-care physicians of a fracture for all patients and only 4% indicated that they provide information about osteoporosis. The main themes that emerged from the four patient focus groups (n=21) were lack of continuity of care, the absence of a link between the fracture and osteoporosis by both patients and health care providers, and need for information. Most participants agreed that something was needed to prompt their primary-care physician to investigate for osteoporosis. The four physician focus groups (n=26) identified a role for orthopaedic surgeons to flag cases.
From 34 key informant interviews with community-based organizations, we found a lack of integration between health care professionals who provide fracture care and those who provide osteoporosis management and fall prevention. Based on these data, we developed an integrated local-resource-based post-fracture care model, which we obtained feedback on at a stakeholder consultation workshop. The model focuses on improving emergency department/fracture clinic communication, emphasizes the need for follow-up investigation by family physicians for osteoporosis, and incorporates other health care professionals and a telemedicine multidisciplinary osteoporosis clinic. We are currently evaluating whether this model leads to an increase in appropriate investigation of and treatment for osteoporosis in patients with low-trauma fractures.
KeywordsDiagnosis Health services Low-trauma fracture Osteoporosis Treatment
- Development of an integrated-care delivery model for post-fracture care in Ontario, Canada
Volume 17, Issue 9 , pp 1337-1345
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- Author Affiliations
- 1. Department of Physical Therapy, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada
- 2. Osteoporosis Research Program, Sunnybrook & Women’s College Health Sciences Centre, Women’s College Site, 76 Grenville St., 8th floor, Toronto, ON, M5S 1B2, Canada
- 3. Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, 600 University Ave., Suite 413, Toronto, ON, M5G 1X5, Canada
- 4. Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Ave., Room G1-39, Toronto, ON, M4N 3M5, Canada
- 5. St. Michael’s Hospital, 55 Queen St. East, Suite 800, Toronto, ON, M5C 1R6, Canada
- 6. Continuing Medical Education, University of Toronto, 500 University Ave. Suite 650, Toronto, ON, M5G 1V7, Canada