Hip fractures represent one of the most devastating health events for older adults in long-term care, with half of all fractures in this population occurring at the hip and leading to hospitalization, functional decline, and increased mortality risk. Despite established national osteoporosis guidelines, their implementation remains inconsistent across care facilities, creating a critical gap in preventive care for this vulnerable population.
The PREVENT trial will randomize 122 Ontario long-term care homes to either receive a comprehensive fracture prevention model or continue usual care practices. Each participating facility must house at least 50 residents and utilize the PointClickCare electronic medical record system. The intervention centers on recruiting local opinion leaders and healthcare teams of five to ten providers within each home to champion evidence-based fracture prevention protocols. The study will track hip fracture incidence over one year using generalized estimating equations to account for clustering effects at the facility level.
This pragmatic approach addresses a significant implementation science challenge in geriatric care. Current fracture prevention guidelines often fail to translate into consistent clinical practice, particularly in long-term care settings where residents face the highest fracture risk. The cluster randomization design acknowledges that healthcare interventions in institutional settings must account for facility-level factors and team dynamics. While the protocol represents sound methodology for testing system-level interventions, the effectiveness will ultimately depend on whether the knowledge translation strategies can overcome existing barriers to guideline adherence. The study's focus on hip fractures specifically targets the most consequential fracture type, though broader fracture prevention outcomes would provide additional valuable insights.