Papaioannou Alexandra, Ioannidis George, McArthur Caitlin, Hillier Loretta M, Feldman Sid, Giangregorio Lora, Jaglal Susan, Jain Ravi, Van der Horst Mary-Lou, Adachi Jonathan
McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada.
McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada.
J Am Med Dir Assoc. 2021 Jan;22(1):36-42. doi: 10.1016/j.jamda.2020.07.003. Epub 2020 Aug 14.
The Ontario Osteoporosis Strategy for long-term care (LTC) aims to support fracture risk-reduction. LTC specific recommendations for fracture prevention were developed in 2015. This article describes the use of the Knowledge-to Action framework to guide the development and application of research evidence on fracture prevention in older adults. Knowledge translation activities highlighted fractures as a significant source of morbidity in LTC, significant gaps in fracture risk assessment and treatment, and barriers and facilitators to guideline implementation. Multifaceted knowledge translation strategies, targeting staff in LTC homes in Ontario, Canada to support fracture guideline implementation have included education, audit and feedback, team-based action planning, and engagement of LTC residents, their families, and health professionals. Provincial administrative databases were accessed to monitor fracture rates between 2005 and 2015. Our research has identified enablers and barriers to knowledge use such as limited knowledge of osteoporosis, fracture risk, and prevention. Province-wide over a 10-year period, hip fracture rates in LTC decreased from 2.3% to 1.9%, and any fracture rates decreased from 4% to 3.6%. This body of work suggests that multifaceted knowledge translation initiatives are feasible to implement in LTC and can improve the uptake of clinical recommendations for fracture prevention. A key aspect of our fracture prevention knowledge translation activities has been the full engagement of key stakeholders to assist in the co-development and design of knowledge translation products.
安大略省长期护理骨质疏松症战略旨在支持降低骨折风险。2015年制定了针对长期护理机构的骨折预防具体建议。本文描述了如何运用知识转化框架来指导老年人骨折预防研究证据的开发与应用。知识转化活动强调骨折是长期护理机构中发病的一个重要来源，骨折风险评估和治疗存在显著差距，以及指南实施的障碍和促进因素。针对加拿大安大略省长期护理机构工作人员以支持骨折指南实施的多方面知识转化策略包括教育、审核与反馈、基于团队的行动计划，以及长期护理机构居民、其家人和卫生专业人员的参与。利用省级行政数据库监测2005年至2015年期间的骨折发生率。我们的研究确定了知识应用的促进因素和障碍，如对骨质疏松症、骨折风险和预防的认识有限。在全省范围内，经过10年时间，长期护理机构中的髋部骨折发生率从2.3%降至1.9%，任何骨折的发生率从4%降至3.6%。这项工作表明，多方面的知识转化举措在长期护理机构中实施是可行的，并且可以提高对骨折预防临床建议的采纳率。我们骨折预防知识转化活动的一个关键方面是关键利益相关者的充分参与，以协助共同开发和设计知识转化产品。
