title: Optimizing care in osteoporosis: the Canadian quality circle project.
abstract: BACKGROUND
  While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines.
  
  
  METHODS
  The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.
  
  
  RESULTS
  After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7).
  
  
  CONCLUSIONS
  Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.
authors.affiliation: Department of medicine, McMaster University, Hamilton, Ontario, Canada. g.ioannidis@sympatico.ca
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Anthony
authors.initials: A
authors.lastname: Hodsman
authors.forename: Brent
authors.initials: B
authors.lastname: Kvern
authors.forename: Dan
authors.initials: D
authors.lastname: Johnstone
authors.forename: Nathalie
authors.initials: N
authors.lastname: Plumley
authors.forename: Lena
authors.initials: L
authors.lastname: Salach
authors.forename: Famida
authors.initials: F
authors.lastname: Jiwa
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002170:Canada; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008403:Mass Screening; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012307:Risk Factors