Co-leads:
- Sonia Singh
Fraser Health
- Larry Funnell
Patient partner
- Tania Bubela
SFU
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Executive sponsor:
- Linda Dempster
Fraser Health
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Low-trauma fractures (which occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis and can lead to significant disability, and even death, for patients. One low-trauma fracture often leads to a cycle of recurrent fracture. For example, approximately 50 percent of patients who suffer a hip fracture have a history of past fracture.
In BC, the annual cost for osteoporosis-related fractures has been estimated at $269 million for hospital care, Medical Services Plan and Pharmacare alone. Despite the availability of effective treatments that reduce future fracture risk by up to 50 percent, less than 20 percent of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.
The evidenced-based Fracture Liaison Services (FLS) model has been adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who captures the patient at the point of orthopedic care for the low-trauma fracture and integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link fracture patients with community family physicians to ensure sustainability and follow-through of initiated interventions to prevent another fracture.
In 2012, the Secondary Fracture Prevention Research Team in Fraser Health (FH) brought together osteoporosis and fall prevention experts to develop an FLS model that fit the context of the BC health-care environment. In 2015, the model was implemented at Peace Arch Hospital (PAH).
A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions taken up by low-trauma fracture patients in the FLS group compared with a control group. FLS is now a permanent program at PAH. In this project, the team will explore how the FLS model implemented at one hospital can be successfully adapted and scaled-up to other hospital sites within FH.
Consolidated Framework for Implementation Research (CFIR) 16 will inform the teamâs implementation strategy and the RE-AIM 17 model will frame the process and outcome evaluation. The key outcome is to inform an FLS implementation strategy that can be used to spread the FLS model across BC, thereby improving patientsâ quality of life after low-trauma fractures and decreasing health care costs related to recurrent fracture.
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Executive sponsor:
- Matt Herman
BC Ministry of Health
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A large proportion of Canadians are approaching older age. Those older than 65 will comprise more than 30 percent of Canadaâs population by 2050. An increasing number of older adults are unable to sustain their health and are negatively affected by chronic disease, social isolation or mobility issues.
Despite the inextricable link between physical activity and chronic disease prevention, older adults are the least active Canadians. Thus, strategies that effectively enhance physical activity are key for preserving older adultsâ health and independence.
In partnership with the BC Ministry of Health, the team developed an effective health promotion intervention for older adults called Choose to Move (CTM) that was scaled-up across BC. In CTM, older adults work with an activity coach to choose physical activities they like and are able to do. The scale-up study demonstrated that CTM increased older adultsâ physical activity, mobility and social connectedness.
For this project, the team will focus on a part of implementation science called the âscale-outâ which is defined as an extension of âscale-upâ; it refers to the use of strategies to implement an evidence-based intervention to new populations and/or through new delivery systems. Simply speaking, the team will adapt CTM so that it can be implemented by different community organizations (delivery partners) in 16 rural and remote communities across BC, as well as with older adults of low income in Vancouver. With delivery partners, the team will monitor changes that enable a âbest fitâ for CTM in older adults who live in different communities across BC. The team is guided by the Framework for Successful Implementation.
The projectâs specific research objectives are to:
- Describe implementation strategies that support CTM at scale-out.
- Describe how CTM is adapted for scale-out.
- Assess the impact of CTM on older adultsâ physical activity, mobility, social connectedness and loneliness.
The guideline document that will be created through this project will be able to be used to direct processes, strategies and evaluation of health promotion initiatives for other programs and practices within public health and health services sectors.
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Each year, 30 percent of seniors have at least one fall â half of whom fall more than once. In fact, nine out of 10 hip fractures result from falls.
Fortunately, falls are preventable. There is strong evidence that the Otago Exercise Program, which consists of strength and balance training delivered by a physiotherapist, can reduce falls in this population. Seniors who are at risk of a fall are the prime population to benefit from the Otago program, but as little as 25 percent of people who start the program continue with it over time.
The research team recently demonstrated that exercise coaching with the use of a consumer wearable, such as a Fitbit, was feasible and could help older adults with chronic disease to stay active. A key element was to empower the person to develop realistic exercise goals.
In this project, the team will test two methods of delivering the Otago program, which includes a new coaching approach by a physiotherapist and the use of a Fitbit to provide feedback (versus the traditional delivery, which is the current standard).
The team will measure success by the degree to which the program is delivered as intended, and the degree to which it is followed by seniors at 12, 18 and 24 months. The number of falls, risk of falling, and participation in walking activities between the two groups will also be assessed over time. In addition, the team will assess whether the coaching approach is a cost-effective option for delivering the Otago program.
Given the serious consequences, fall prevention is a high priority in BC. To this end, the team has brought together a team of national leaders in fall prevention and implementation science, as well as health system partners and a prominent national patient group to address this important issue.
