New toolkit by APCO to promote quality improvement in osteoporosis care

The Asia Pacific Consortium on Osteoporosis (APCO) recently launched the Bone Health Quality Improvement (QI) Tool Kit to promote better osteoporosis care.

The toolkit is timely as more than 50 percent of the world’s hip fractures are anticipated to occur in the Asia Pacific region over the next 2 decades, said Dr Manju Chandran, APCO chairperson and director of the Osteoporosis and Bone Metabolism Unit, Singapore General Hospital, Singapore. The complete toolkit consists of several elements for the screening, diagnosis, and management of osteoporosis.

The kit is based on seven applicable standards from The APCO Framework* and the QI will be implemented using iterative Plan-Do-Study-Act (PDSA) cycles. “Once the audits (into the current osteoporosis care regimens) are completed, healthcare professionals (HCPs) and medical centres can commence implementing changes to their clinical practice. APCO is in the process of engaging QI experts to help train APCO members to perform such projects in their individual medical centres and practices,” said Chandran. The APCO audit focuses on examining the patient pathway, identifying the gaps or lost opportunities for patients at risk, and then utilizing the PDSA activity to enhance the quality of treatment and make recommendations.

“Previous audits have focused on just a single aspect of osteoporosis care, namely the identification and appropriate management of osteoporotic fragility fractures. A perfect storm of a rise in osteoporosis among Asia-Pacific populations is expected to occur due to the region’s rapidly ageing population, mounting urbanization, and subsequent increase in sedentary lifestyles,” said Manju. [Osteoporos Int 2021;32(7):1249–1275]

Shared objective among HCPs necessary to avert osteoporosis avalanche
The likelihood of successfully initiating change to avert a bone health crisis will primarily depend on the efforts of HCPs to engage their peers in the pursuit of shared objectives, said Dr Hew Fen Lee, consultant physician and endocrinologist, and APCO committee member. By articulating the benefits of the APCO Bone Health QI activity, participation and cooperation can be increased.

“The critical factors to success include having a supportive organizational culture, good design and planning, and follow through on results, ensuring the data collection is meaningful and achievable,” said Hew. He added: “Data collected through the audit should be used to benchmark practice against the standards recommended by The APCO Framework. This will show stakeholders that the audit was worth the effort, and that it contributed to tangible change.”

Dr Philippe Halbout, chief executive officer, International Osteoporosis Foundation, Switzerland, said lessons from implementing these [APCO] clinical standards at the institutional level will be key to achieving change at the national level, through the development, or revision of national guidelines, and policy change. “These coordinated systems of care aim to identify, treat and monitor patients with osteoporosis. Timely intervention can reduce fractures … deliver substantial financial savings, and ultimately, save lives.”

The APCO Bone Health QI Tool Kit aims to overcome the under-diagnosis and under-treatment of osteoporosis in Asia by:

• Understanding the baseline variables and current state of osteoporosis care in any given institution or healthcare practice.
• Enabling benchmarking clinical practice against The APCO Framework, evidence-based clinical practice guidelines or established protocols for the chosen standard of care.
• Using the findings to then improve the quality of care through iterative PDSA cycles.
• Using the lessons learned from implementation of the APCO Clinical Standard at an institutional level, to build momentum and work towards inclusion of the quality improvement/ clinical standard in national guidelines, and lobbying for funding and policy change, as appropriate.