title: Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.
abstract: BACKGROUND
  Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months.
  
  
  METHODS
  We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes.
  
  
  RESULTS
  At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively.
  
  
  CONCLUSIONS
  Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. kennedyc@hhsc.ca.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Kennedy
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. g.ioannidis@sympatico.ca.
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. thabanl@mcmaster.ca.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. adachi@sympatico.ca.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. marrs@mcmaster.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Marr
authors.affiliation: University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca.
authors.forename: Lora M
authors.initials: LM
authors.lastname: Giangregorio
authors.affiliation: McGill University, 845Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada. suzanne.morin@mcgill.ca.
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: Western University, Parkwood Hospital, 801 Commissioners Road East, London, ON, N6C 5 J1, Canada. crilly@sjhc.london.on.ca.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Crilly
authors.affiliation: University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. josser@smh.toronto.on.ca.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. lohfeld@mcmaster.ca.
authors.forename: Lynne
authors.initials: L
authors.lastname: Lohfeld
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. pickardl@hhsc.ca.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Pickard
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. dhm9@xplornet.com.
authors.forename: Mary-Lou
authors.initials: ML
authors.lastname: van der Horst
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ecampbell49@quickclic.net.
authors.forename: Glenda
authors.initials: G
authors.lastname: Campbell
authors.affiliation: Medical Pharmacies Group Limited, 590 Granite Crt, Pickering, ON, L1W 3X6, Canada. jstroud@medicalpharmacies.com.
authors.forename: Jackie
authors.initials: J
authors.lastname: Stroud
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ldolovic@mcmaster.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. sawka@uhn.on.ca.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.affiliation: Osteoporosis Canada, Suite 301, 1090 Don Mills Road, Toronto, ON, M3C 3R6, Canada. RJain@osteoporosis.ca.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jain
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. nashl@mcmaster.ca.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nash
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. papaioannou@hhsc.ca.|Division of Geriatrics, Department of Medicine, McMaster University, Geriatric Education and Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, Room 151, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. papaioannou@hhsc.ca.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use*; D003299:Cooperative Behavior; D019587:Dietary Supplements; D011307:Drug Prescriptions; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007318:Inservice Training; D033183:Interdisciplinary Communication; D008134:Long-Term Care / Q000592:standards; D008297:Male; D009735:Nursing Homes; D016017:Odds Ratio; D009864:Ontario; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control; D010348:Patient Care Team; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D013997:Time Factors; D057170:Translational Research, Biomedical / Q000379:methods*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium