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Open Access Study protocol

Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design

Monika Kastner15*, Anna Sawka2, Kevin Thorpe35, Mark Chignel4, Christine Marquez5, David Newton5 and Sharon E Straus56

Author Affiliations

1 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

2 Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada

3 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

4 Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada

5 Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada

6 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

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Implementation Science 2011, 6:77  doi:10.1186/1748-5908-6-77

Published: 22 July 2011

Abstract

Background

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care.

Methods

A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care.

Discussion

The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.