title: Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial.
abstract: We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management.
  
  
  BACKGROUND
  To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control).
  
  
  METHODS
  A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was 'appropriate' management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications.
  
  
  RESULTS
  Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3-4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0-7.0).
  
  
  CONCLUSIONS
  A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists.
authors.affiliation: Toronto Rehabilitation Institute, Toronto, ON, Canada. susan.jaglal@utoronto.ca
authors.forename: S B
authors.initials: SB
authors.lastname: Jaglal
authors.forename: O S
authors.initials: OS
authors.lastname: Donescu
authors.forename: V
authors.initials: V
authors.lastname: Bansod
authors.forename: J
authors.initials: J
authors.lastname: Laprade
authors.forename: K
authors.initials: K
authors.lastname: Thorpe
authors.forename: G
authors.initials: G
authors.lastname: Hawker
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: L
authors.initials: L
authors.lastname: Meadows
authors.forename: S M
authors.initials: SM
authors.lastname: Cadarette
authors.forename: A
authors.initials: A
authors.lastname: Papaioannou
authors.forename: M
authors.initials: M
authors.lastname: Kloseck
authors.forename: D
authors.initials: D
authors.lastname: Beaton
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.forename: M
authors.initials: M
authors.lastname: Zwarenstein
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration; D012737:Sex Factors
chemical_list: D050071:Bone Density Conservation Agents