Table 3 Potential strategies, mode of delivery, and APEASE criteria
BCWIntervention Function | Themes | Strategies in the context of implementing the Fracture Risk CAP | Mode of Delivery | Does it meet APEASE? |
|---|---|---|---|---|
Training | Training on CAP usage | • Mandatory onboarding training | Online or in-person | Yes, with minor concern of shifting the focus from other health concerns in LTC (e.g. pressure ulcers) |
• Train the trainer – with follow-up support with multiple touchpoints, feedback, and regular positive reinforcement | ||||
• Train the early change adopters to be trainers |  |  | ||
Environmental restructuring | Culture change | • Change the social context by empowering personal support workers, volunteers, and families | LTC home policy and practices change | May not be acceptable to some due to sharing of power. Potential side effect of individuals performing tasks out of their scope. |
• Changing model of care to better include physicians and pharmacists | ||||
• Consistent staffing | ||||
• Promote team responsibility and promote inclusivity | ||||
Resident-centered care | • Sharing the CAP or assessment results with residents and families | Electronic portal. Resident-family conferences. | Family sharing portal may be costly to develop. May not be practicable, effective, or acceptable due to cost and lack of interest or availability for some families. | |
• Family and resident-led huddles with staff during quarterly and annual reviews | ||||
• Working with family to balance individual rights, autonomy, freedom, and safety | ||||
Physical restructuring | • Physical modifications to the LTC home to reduce fractures and promote collaboration (e.g. handrails, open space) | Physical changes to the layout of the LTC home | Not discussed | |
• Making the CAP easily accessible to all members on the care team | Virtual dashboard | Not discussed | ||
Minimize any increase in workload | • Standardized process once a high Fracture Risk Scale score is generated • Integration of the CAP into the existing processes (e.g. annual care conferences) | Care processes | Yes | |
Enablement | Software features | • Software add-on with the following features: flags staff only when meaningful changes occur, provide easy access to historical data, identify actionable things, perhaps targeted to person who can implement | Software | Development time may not be practicable. Side-effect: alarm fatigue taking away attention from other health conditions. |
Modeling | Building modeling into training | • Case-study• Build into education by role-playing• Collaboration with multiple disciplines during the training stage to model real-life | In-person,videos | Not discussed. |
Education | Education for staff | • Resources & materials tailored to different roles, easy access to reference tool that can be taken to bedside and used as part of training e.g., on tablet, on website • Patient-focused education for staff with simple and clear messaging • Take an interprofessional approach and improve physician involvement | Micro-learning and E-learning sessions,annual in-service,professional advisory meetings | More affordable if it’s online. Potential side effect of people burning out from training and time taken away from staff. |
Education for residents and families | • Importance of guidelines and how to advocate for following guidelines | One-page pamphlet with actionable items, resident-family conferences | Yes, as long as it is targeted to those at high fracture risk, available in multiple formats, factually accurate, and easy to understand. | |
Persuasion | Persuasion through stories | • Highlighting patient stories / identifying an important problem to show the impact of fractures • Value proposition by storytelling • Highlight reduced workload and increased QoL related to guideline usage | Posters or videos, social media and announcement channel or screen in LTC homes | Yes, as long as the visuals are made for the home, include gender and racial diversity, available in multi-media formats, and changed regularly |
Incentivization | Social reward | • Recognition from organizations (i.e. Osteoporosis Canada) | Acknowledgement from organization – hard (i.e., plaque) or soft (i.e., seal of approval on website) copy | Not discussed |
Material reward | • Award the ward with the lowest fracture rate • Flip case-mix funding to incentivize functional improvement, since the current case-mix model decreases that incentive | Financial, food (e.g., pizza party), material good (e.g., t-shirts) | Not discussed | |
Coercion | Public benchmarking | • Public benchmarking, against Canadian provinces or other countries | Publicly accessible online dashboard | Potential side effect of underreported cases. |
Restriction | Regulations | • Fracture Risk Scale score and associated care plan as criteria for use of osteoporosis medication • Ministry of Health mandates use of up-to-date Fracture Risk Assessment and Prevention Tools | Policies and procedures | Not discussed |