Development of an integrated-care delivery model for post-fracture care in Ontario, Canada.
BACKGROUND
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.


METHODS
In 2002, questionnaires were completed for 178 eligible hospitals.


RESULTS
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.


CONCLUSIONS
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.
Jaglal
S B
SB
Department of Physical Therapy, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada. susan.jaglal@utoronto.ca
Cameron
C
C
Hawker
G A
GA
Carroll
J
J
Jaakkimainen
L
L
Cadarette
S M
SM
Bogoch
E R
ER
Kreder
H
H
Davis
D
D
D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017144:Focus Groups; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D017146:Models, Organizational; D009864:Ontario; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010353:Patient Education as Topic; D012017:Referral and Consultation / Q000458:organization & administration