REPORTBACK FROM STRATEGIC PLANNING SESSIONS

1. REPORTBACK FROM STRATEGIC PLANNING SESSIONS 24 October 2009

2. Order of presentations • Africa • Asia • Europe • Latin America • Middle East • North America • Pacific • Prof Moody • Kai Ming • Liana • Marcos • Ghassan • Amy/Josh • Peter

3. Rankings

4. Arthritis • Global Objective: By 2015, there will be guidelines for arthritis and other major rheumatic conditions (AORC) that will be adapted and implemented by each region’s/country’s National Action Network to improve prevention and early diagnosis • Global Strategies: • Demonstrate cost-effectiveness • Create patient demand • Harmonize guidelines across organizations

5. Bone health / Osteoporosis • Global Objective: By 2020, detection of any osteoporotic fracture should initiate a pathway of care in all patients which can be individualized to settings in different countries to address secondary prevention • Global Strategies: • Develop logistics for continuum of care, with systems approaches that are cost effective. • Develop metrics for systems that measure how this is a good investment for policy makers (e.g. registries, outcome measures, understanding failures in systems, on cost effectiveness, comparative-effectiveness). • Advocate to make this a government health care priority.

6. Pediatric MSDs – Healthy Lifestyles • Global Objective: Decrease the incidence of obesity related musculoskeletal disorders such as Blount’s Disease and Slipped Capital Femoral Epiphysis by X% by the year 2020.  • Develop partnerships with NGOs such as the YMCA and Boays and Girls clubs to educate children in nutrition and dietary counselling • Undertake public affairs lobbying for tax credits or direct governmental or industry support funding of pilots • Standardise exercise programmes •   - Roll out in after school programmes • Global Objective: By 2020 increase the number children receiving adequate Calcium, vitamin D and mineral intake by X% • …. • 2. Optimizing Bone, Joint and Muscle Function in Children with Chronic Neuromuscular and Musculoskeletal Disorders/Transition to adult care • Access to appropriate care/medical home • Global: • By 2020 BJD will develop coordinated pilot programs for appropriate multidisciplinary care of children and adults with childhood onset chronic musculoskeletal disorders in X countries. • Goal: By 2020, develop evidence based pathways with regard to care of children with chronic childhood musculoskeletal disorders that are readily accessible and easily understood so that primary care physicians, patients and parents around the world can understand the important basics of care for children for at least X specific disorders. • Strategies: • Coordinate with organizations such as the COCWD of the AAP to ensure access to appropriate care. • Educate primary care practitioners to provide appropriate care. • Advocate for governmental support to ensure access to care for all individuals with childhood onset chronic musculoskeletal disorders.

7. Pediatric MSDs – Optimising function in children with chronic neuro- and MSDs • Global Objective: By 2020 BJD will develop coordinated pilot programs for appropriate multidisciplinary care of children and adults with childhood onset chronic musculoskeletal disorders in X countries. • Strategies: • Coordinate with organizations such as the COCWD of the AAP to ensure access to appropriate care. • Educate primary care practitioners to provide appropriate care. • Advocate for governmental support to ensure access to care for all individuals with childhood onset chronic musculoskeletal disorders

8. Research • Global Objective: By 20xx, develop musculoskeletal centers of research that are integrated with clinical and basic science disciplines and develop dynamic regional/national networks (possibly based on German MSD network “model”) to improve research being conducted in a holistic, multi-disciplinary manner • Global Strategies: • Incorporate research component into NANs’ activities – and they should coordinate research agendas at global, regional and national levels • Identify funding sources to facilitate this • Add research mission into BJD global/ regional articles • Initiate a training pipeline earlier

9. Spinal disorders / Lower back pain • Global Objective: By 2015, identify disparities in existing guidelines for management of spinal disorders to direct future research (with goal of multicenter/multidisciplinary research proposals from BJD investigators) to improve collaborative research/education • Global Strategies: • Review existing published guidelines, identify disparity • Raise awareness of research needs directed toward resolution of disparities • Create alignments with industry and public health organizations through education

10. Trauma & Injury • Global Objective: By 2015, decrease the incidence of road traffic crashes by 10-15% • Global Objective: By 2020, decrease the incidence of fragility fractures by X% • Global Strategies: • Identify best practice around existing traffic safety policies • Develop databases to allow for effective measurement • Public awareness campaigns • Global Strategies: • Promote the development of clinical pathways (focus on handoff communications • Patient education on fall prevention, exercise, home safety

11. Africa Region

12. Regional Actions – Trauma • Regional goal (same as global): Reduce incidence of RTC by 15% in 10 years • Regional strategies • Public awareness campaigns • Promote law enforcement • Specific regional actions • Lobby governmental decision-makers to fund public education programs, highway rest areas, etc • Strengthen monitoring and enforcement systems for vehicle inspections, traffic surveillance, etc

13. Regional Actions – Research • Promote better and more comprehensive research, including accurate coding • Build and support better regional communications using BJD network • Human resources – need the people • ACTIONS:~ Regional audits of practice • Education in residency and hospitals • Support infrastructure development

14. Asia Region

15. Regional activities Asia • Trauma • Prevention • Legislation (seatbelt, helmets) • Law enforcement • LOCAL ACTION • Education (public awareness + professional outreacch) • Law enforcement • Alcohol control • Cellphone distraction • Transportation System – separating pedestrian from road and encourage mass transit • Pre-Hospital medical care • Coordinated use of resources – special trauma centre

16. Regional activities Asia Fragility fracture • Prevention • Education • Nutrition • Fall prevention • Exercise • Regulation of patient information • Collect data (research theme) • Management • Evidence based clinical pathway • Effective affordable inplant • Improve surgical care • Special centres (osteoporosis)

17. Europe Region

18. Regional Actions – Integration! • Develop integrated approach to arthritis, osteoporosis, spinal disorders (all have equal priority) • All activities and topics should include research and patient advocacy which should be integrated

19. Integrated Guidelines • By 2015, to have each country/NAN/region implement integrated guidelines on prevention and management of MSDs and evaluate them • Holistic, patient-centred approach to: • Prevention • Diagnosis • Management • Patient education • Rehabilitation • Social and work conditions

20. Strategies • Collect, refine and harmonise evidenced-based guidelines • Demonstrate cost-effectiveness of guidelines to gain endorsement • Create patient advocacy/demand for guidelines to be implemented

21. Tactics • BJD library/website • Media outreach • Public Affairs engagement • Developing patient-based metrics

22. Objectives • To create MS research science centres: • by 2011 one at least in each country • By 2015, 10 further in Europe • By 2020, 10 another 10 in Europe

23. Strategies • Prioritise research on agenda of every national and international council meeting/NAN • Audit of NAN expertise and capabilities to improve in future

24. Tactic • KOLs in research should be included (also to source funding) • Involvement of Primary Care societies • Involvement of patient groups (patient expertise) from the very beginning of the process

25. A Call to Action • BJD = a very powerful too to make all this possible if we all work together!

26. Latin America Region

27. Regional Actions – Trauma • Regional goal: Reduce mortality and morbidity by 5% in the first year, then 2% more per yeard and achieve 20% in 10 years. • Concept: Safe and Healthy Traffic • Strategies/Actions • Use WHO/supranational organisations to gain access to Latin American political audiences • Use the Latin American ‘cupula’ with presidents/ministers and parliamentarians to adopt a CONTINENT WIDE policy of education and law enforcement • Pilot sutdy in 5 countries • Public awareness campaign

28. Regional Actions – Bone Health • Regional goal: Increase secondary prevention through research and data • Promote prevention with educational campaigns and recommendations to make secondary fracture prevention an MSK priority • Support checklists and treatment pathways for international recommendations

29. Middle East Region

30. Regional Action 1 • By 2015, involve all organizations in the region dealing with osteoarthritis to develop guidelines for policy-makers and health care professionals • Raise awareness via media • Create arthritis website linked to BJD • Create an arthritis foundation in the region within the global strategy of BJD goals • Activate societies to create a group to develop guidelines for prevention, early diagnosis and treatment

31. Regional Action 2 • Organizational objective: Create a NAN in each country of the region • Make the existing specialized societies work toward producing guidelines for patients and health care professionals • Create the Middle East group of the BJD • Encourage research specific to the region • Develop a strategy to influence registration for MSD conditions

32. North America Region

33. Regional Actions for Research • Create Integrated multidisciplinary research groups • Create consortia/institutes with basic, clinical, translational, health service, and community-based research which includes PPPs and emphasizes systems approach to MSDs (T1-T2-T3) • Enhance training pipeline (high school, undergrad, pre-professional, professional) • Network of consortia

34. Outcomes • By 2015… • There will be 5 consortium members • Standards/Metrics (possibly registries) will be defined by the consortia and fed into a global standard framework • Research will be included/emphasized in NANs’ missions • Increase research funding by x% and measure ROI • Metrics will be developed to measure clinical impact

35. Pacific Region

36. Regional Actions – Pediatric MSD Prevention • Goal: Reduce incidence of obesity among target populations by x% to prevent MSDs related to obesity • By 2015, create guidelines for each of the major MSDs that would be adapted by each NAN • Create patient demand • Communication to patients (but question of branding? Is it BJD, Is it IOF, Is it …? ) • Identify and develop champions • Harmonise guidelines for diagnosis, treatment, person-related outcome measures (behavioural goals for at-risk patients)

37. Regional plan: Research • Build a cost-effective evidence base on MSDs • Develop guidelines, registries for rare and common diseases (particularly joint registries) • Share and exchange data • Use to drive patient-shared decision-making and facilitate development of person-centered pathways • Create website to disseminate research, educate patients and health care professionals