IQ driving QI: the Asia Pacific Consortium on Osteoporosis (APCO): an innovative and collaborative initiative to improve osteoporosis care in the Asia Pacific

Chan, Ding‐Cheng; Bhadada, Sanjay; Ebeling, Peter R.; Gilchrist, Nigel; Khan, Aysha Habib; Halbout, Philippe; Lekamwasam, Sarath; Lyubomirsky, Greg; Mitchell, P. J.; Nguyen, Tuan V.; Tiu, K. L.

doi:10.1007/s00198-020-05495-w

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…Adoption of such strategies would lessen the burden of osteoporosis in this vast region that accounts for more than 60% of the world’s population [ 5 ]. We have previously described APCO’s raison d’etre , conception and launch, vision, mission, and priority initiatives [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Chan

Mitchell²,

Amphansap

et al. 2021

Osteoporos Int

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Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporosis and for improving the quality of care. Purpose Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development. Methods We conducted a structured comparative analysis of existing CPGs in the AP region using a "5IQ" model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards. Results Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines. Conclusion The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis.

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Section: Introductionmentioning

confidence: 99%

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Chan

Mitchell²,

Amphansap

et al. 2021

Osteoporos Int

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“…The Asia Pacific Consortium on Osteoporosis (APCO) is an independent, apolitical, and nonpartisan organization comprised of osteoporosis experts from 19 AP countries and regions. ( 15 ) It represents many key osteoporosis stakeholders and multiple medical and surgical specialties. APCO has tasked itself to develop tangible solutions to the substantive challenges involving osteoporosis management and fracture prevention in this most populated and fastest growing region of the world.…”

Section: A Potential Solutionmentioning

confidence: 99%

“…A survey that we executed in 2020 revealed that the AP region had 18 extant CPGs. ( 15 ) When we analyzed the CPGs, we observed that they were published by different learned bodies, differed in format, and diverged strikingly in the guidance they provided. It was observed that some countries in our region had no guidelines and in others they were out of date; in other countries, guidelines prepared by specialty and subspecialty societies addressed a narrower spectrum of interest limited to the providers in that society.…”

Section: A Potential Solutionmentioning

confidence: 99%

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Harmonization of Osteoporosis Guidelines: Paving the Way for Disrupting the Status Quo in Osteoporosis Management in the Asia Pacific

Chandran

Ebeling

Mitchell

et al. 2020

Journal of Bone and Mineral Research

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In the Asia Pacific (AP) region, osteoporosis and its consequence of fragility fractures are not widely recognized as a major public health problem. Several challenges including underdiagnosis and undertreatment exist. The Asia Pacific Consortium on Osteoporosis (APCO) is a nonpartisan and apolitical organization comprising musculoskeletal experts and stakeholders from both private and public sectors who have united to develop tangible solutions for these substantive challenges. APCO's vision is to reduce the burden of osteoporosis and fragility fractures in the AP region. Heterogeneity in both scope and recommendations among the available clinical practice guidelines (CPGs) contribute to the large osteoporosis treatment gap in the Asia Pacific. APCO has therefore developed a pan Asia‐Oceania harmonized set of standards of care (The Framework), for the screening, diagnosis, and management of osteoporosis. First, a structured analysis of the 18 extant AP CPGs was completed. Subsequently, a prioritization of themes and agreement on fundamental principles in osteoporosis management were made through a Delphi process of consensus building. This approach, ensuring the opinions of all participating members were equally considered, was especially useful for a geographically diverse group such as APCO. It is hoped that the Framework will serve as a platform upon which new AP national CPGs can be developed and existing ones be revised. APCO is currently embarking on country‐specific engagement plans to embed the Framework in clinical practice in the AP region. This is through partnering with regulatory bodies and national guidelines development authorities, through peer‐to‐peer health care professional education and by conducting path finder audits to benchmark current osteoporosis services against the Framework standards. The principles underpinning the harmonization of guidelines in the AP region can also be utilized in other parts of the world that have similar socioeconomic diversity and heterogeneity of healthcare resources. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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“…APCO is comprised of 39 experts in osteoporosis from 19 countries and regions. 4 APCO determined that the existing clinical guidelines for osteoporosis in countries in the Asia-Pacific were too varied in scope and recommendations, through a comprehensive and comparative review. In addition, there are many low-and middle-income countries (LMICs) where no guidelines exist.…”

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confidence: 99%

Need for Clinical Guidelines for Management of Osteoporosis and Way Forward for Pakistan

Khan

Chandran

2021

J Coll Physicians Surg Pak

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IQ driving QI: the Asia Pacific Consortium on Osteoporosis (APCO): an innovative and collaborative initiative to improve osteoporosis care in the Asia Pacific

Cited by 12 publications

References 10 publications

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Harmonization of Osteoporosis Guidelines: Paving the Way for Disrupting the Status Quo in Osteoporosis Management in the Asia Pacific

Need for Clinical Guidelines for Management of Osteoporosis and Way Forward for Pakistan

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