The aim of this thesis is to examine the relationship of all corporate governance indicators with firm performance (proxied by price to book value) and tax fees. Using a sample of 133 large U.S firms, in a single model, we explore the correlation of price to book value with board of director's structure (composition and size). Our results show that smaller and younger boards with less independent directors lead to a higher firm performance. We further find that presence of women on board is important rather than their number. The outcome of the study shows also that financial expertise of audit committee members has a significant and positive influence on the amount of tax fees. Overall, the results suggest that board characteristics are important and they influence firm performance. Keywords: board of directors, firm performance, price to book value, governance indicators, tax fees.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Distant education is a growing teaching education modality. Supported by the Technologies of Information and Communication (TICs), the system is capable to involve people and/or institutions that before haven t had access to the higher education. The concern with the quality and the inherent responsibility the operation dynamics is fundamental point, that still deserves studies, so much in graduation level as masters degree. The general objective of this dissertation is to propose performance indicators to aid the planning and masters degree latu sensu distance education courses management . The research was characterized as an exploratory-descriptive nature, the method a was case study in the masters degree latu sensu Course in Distance Special Education Modality from UFSM. Such a course was presented in five poles of performance: Uruguaiana (RS), Santana do Livramento (RS), Bagé (RS), Santa Maria (RS) and Presidente Prudente (SP). The collection of data involved the accomplishment of semi-structured interviews applied to the coordinators of the Course teachers, tutors and students, what made possible a better understanding on the development of the Course, in a pilot project of the University. The questionnaire was supported by quality referential from Ministry of Education for distance superior education. The interviewed reports were grouped in the following dimensions: (i) didactic-pedagogic organization; (ii) social body and, (iii) physical facilities. The selected results allowed to propose 19 strategic themes with 95 acting indicators to be managed in distance courses in agreement with Balanced Scorecard perspectives - Financial, Internal Processes, Customers and Learning and Growth - proposed by Kaplan and Norton (1997), besides the technological perspective suggested by Columbus (2004). / A educação a distância se configura numa crescente modalidade de ensino e de educação. Respaldado pelas Tecnologias de Informação e Comunicação (TICs), o sistema é capaz de envolver pessoas e/ou instituições que antes não possuíam acesso ao ensino superior. A preocupação com a qualidade e a responsabilidade inerente a sua dinâmica de funcionamento é ponto fundamental, que ainda merece estudos, tanto em nível de graduação quanto de pósgraduação. O objetivo geral desta dissertação é Propor indicadores de desempenho que subsidiem o gerenciamento de cursos de pós-graduação lato sensu modalidade a distância. . Sendo assim, a pesquisa caracterizou-se pela natureza exploratório-descritiva, tendo como método adotado o estudo de caso aplicado no Curso de Pós-Graduação Lato Sensu em Educação Especial Modalidade a Distância da UFSM. Tal Curso foi ofertado em cinco pólos de atuação: Uruguaiana (RS), Santana do Livramento (RS), Bagé (RS), Santa Maria (RS) e Presidente Prudente (SP). A coleta de dados envolveu a realização de entrevistas semiestruturadas junto aos coordenadores do Curso, professores, tutores e alunos, o que possibilitou um melhor entendimento sobre o desenvolvimento do Curso, tido como um projeto piloto da Universidade. O roteiro de entrevistas teve por base os referenciais de qualidade para educação superior a distância propostos pelo Ministério da Educação, sendo os relatos agrupados nas seguintes dimensões: (i) organização didático-pedagógica; (ii) corpo social e, (iii) instalações físicas. Os resultados apurados permitiram propor 19 temas estratégicos com 95 indicadores de desempenho para serem gerenciados em cursos a distância, que foram explicitados em um quadro resumo organizado de acordo com as perspectivas do Balanced Scorecard - Financeira, Processos Internos, Clientes e Aprendizado e Crescimento - proposto por Kaplan e Norton (1997), além da perspectiva Tecnológica sugerida por Colombo (2004).

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This thesis deals with a company performance management method in compliance with the key performance indicators. It addresses the KPIs' characteristics as well as the design process of the indices and their implementation procedures. It does not only rest with a description of the method itself but it also focuses on the related areas of the research such as managers' approach towards the corporate performance management or the business intelligence discipline. The theoretical part of the thesis focuses on building the model that makes it possible to design the KPIs with an emphasis on a successful delivery of the entire project. The methodology is based on a selection of the right indicators and application of the implementation techniques leading to a successful completion of the project. A special attention is dedicated to the CPM concept as a basic principal from which the key indicators derive. The practical part addresses the respective design of the KPIs. First of all, the KPIs are suggested to a banking institution. Afterwards, these indicators are confronted with the model drawn up in the theoretical part. The indicators are assessed consequently. The main contribution of this thesis is a development of a model that can serve as a guide for a proper KPIs design in a company and can add to a successful completion of the indicators' implementation. The findings of the research conducted for the purpose of this thesis could be put to use by the corporate managers who are interested in approaching the performance management methods also assessed in this dissertation.

Made available in DSpace on 2014-12-17T14:53:21Z (GMT). No. of bitstreams: 1 IsabelaXBB_DISSERT.pdf: 7772080 bytes, checksum: d44de58104ad0eb517d8a5dc7ad758b1 (MD5) Previous issue date: 2014-05-20 / This paper presents the validation of the Performance Indicator System for Projects under Construction - SIDECC. The goal was to develop a system of performance indicators from the macroergon?mica approach, considering criteria of usefulness, practicality and applicability and the concept of continuous improvement in the construction industry. The validation process SIDECC consisted of three distinct models. Modeling I corresponded to the theoretical development and validation of a system of indicators. Modeling II concerns the development and validation of multi- indicator system. For this modeling, we used the Mother of Use and Importance and Multivariate Analysis. Modeling III corresponded to the validation situated, which consisted of a case study of a work of construction of buildings, which were applied and analyzed the results of modeling II. This work resulted in the development of an applied and tested for the construction of an integrated system of performance indicators methodology, involving aspects of production, quality, environmental, health and safety. It is inferred that the SIDECC can be applied, in full or in part, the construction companies as a whole, as well as in other economic sectors / Esta disserta??o apresenta o processo de valida??o do Sistema de Indicadores de Desempenho para Empreendimentos em Constru??o civil SIDECC. O objetivo deste trabalho foi desenvolver um sistema de indicadores de desempenho, a partir da abordagem macroergon?mica, considerando crit?rios de utilidade, praticabilidade e aplicabilidade e o conceito de melhoria cont?nua na ind?stria da constru??o civil. O processo de valida??o do SIDECC consistiu de tr?s modelagens distintas. A Modelagem I correspondeu ao desenvolvimento e valida??o te?rica de um sistema de indicadores. A Modelagem II diz respeito ao desenvolvimento e valida??o multiprofissional do sistema de indicadores. Para esta modelagem, utilizou-se a Matriz de Utiliza??o e Import?ncia e a An?lise Multivariada. A Modelagem III correspondeu ? valida??o situada, que consistiu de um estudo de caso em uma obra da constru??o de edif?cios, onde foram aplicados e analisados os resultados da Modelagem II. Este trabalho teve como resultado o desenvolvimento de uma metodologia aplicada e testada para a constru??o de um sistema integrado de indicadores de desempenho, envolvendo os aspectos de produ??o, qualidade, sustentabilidade ambiental, sa?de e seguran?a do trabalho. Infere-se que o SIDECC pode ser aplicado, integralmente ou parcialmente, nas empresas de constru??o civil como um todo, bem como nas empresas de outros setores econ?micos

This thesis addresses a new management approach - "Corporate Performance Management" (CPM). It sets forth the concept of this new approach as a business performance monitoring and strategic support tool, its assumptions, framework, components, relationship to business intelligence, and related methodologies. Particular focus is placed on "key performance indicators" (KPI), their characteristics, segmentation, methods for their selection, and implementation procedures. The theoretical part of this work is devoted to creating a methodology by which CPM can be effectively implemented on projects in the financial sector with an emphasis on the critical success factors of such a project as a whole. The primary elements of this methodology are the selection of the best possible metrics, the project's overall success and the development of efficient reporting. The practical part of this work initially introduces "Project KPI 2008", which ran in Komerční banka (Czech Commercial Bank), then pits it against the theoretical methodologies defined in the theoretical section. The entire project is then assessed based on the results of the comparison, and finally, conclusions and recommendations are made for the future of this project. The main asset of this thesis is its creation of the afore-mentioned management methodologies and the ideal, course to be taken in implementing a KPI-focused project. This work is valuable not only for investigating key performance indicators themselves, but also as an informative tool for managers who would like to acquaint themselves with or learn more about the CPM concepts in general.

Title: Representation of selected general and specific training indicators in ATC in a selected floorball team. Objectives: Performing a literature review, focusing especially of foreign scientific articles regarding the characteristics of floorball and related fitness training. Monitoring the representation of fitness training in a selected extra-league men's team during all training periods of a chosen annual training cycle (2014/2015) using the newly introduced XPS network software. Methods: Upon completion of the literature review, research was performed by conducting the content analysis of training documents kept during the 2014/2015 annual training cycle ("ATC"). The newly created software was part of the analysis. The software was distributed for the needs of floorball practice. In order to evaluate general categories and specific training indicators, natural selection was employed. Comparison was used to assess selected indicators. In addition, physical fitness was evaluated using selected UNIFITTEST 6 - 60 tests (Měkota, Kovář, 1996); however, this type of assessment does not belong to core of this paper. Results: The results suggest that sports performance is affected, to a degree, by general training indicators such as the number of days or the total of training time. However, the most...

Effective maintenance planning is essential and important in any organisation that is responsible for procuring and managing complex assets. In the marine shipping industry maintenance planning is very significant due to its complexity and the obligations on shipping organisations to comply with certain regulations and requirements. Moreover, improper planning can reduce the ship's availability, which may in turn, be reflected in the revenue of the company. Another issue that requires attention in this field is the cost of maintenance, since improper or inadequate planning could result in breakdowns that could increase the cost of maintenance.This research aims to identify the key factors that affect ship maintenance planning and to provide a framework that can help the decision maker to identify and choose optimum decisions regarding ship maintenance. The research is divided into four stages in order to achieve its objectives and to address the research problem.The first stage is the review of the literature to identify the need for maintenance and to select the key factors that affect maintenance planning. The findings indicate that: maintenance scheduling, selection of maintenance strategy, ship construction, crew compensation, and shipyard selection are the most important factors.The second stage is to evaluate maintenance performance measurements for the marine shipping industry by conducting case study and interviews with professionals involved in the mercantile industry. Semi-structured interviews were conducted with six senior staff experts from three different organisations. The results show that: dry docking scheduling, maintenance costs and budgets, customer satisfaction, employees' satisfaction, classification requirements, and the ship's maintenance requirements are the main factors that have great influence on maintenance planning.The third stage is to develop new methodology to measure the maintenance performance in the marine shipping organisation which is the ship maintenance performance measurement (SMPM) framework. The developed method was validated to assist managers in making the right decisions in ship maintenance planning. The framework was developed based on ten thematic criteria that can be used as indicators for potential organisation growth, i.e., maintenance strategy; dry docking scheduling; budget and costs; the ship's equipment; customer satisfaction; employees; health, safety and environment; learning and growth; classification requirements; and the ship's operation and demands requirements. Interviews were conducted with key personnel from the Kuwait Oil Tanker Company (KOTC) to validate the framework.The fourth stage demonstrates that an optimised schedule for the dry docking of ships for routine maintenance has been constructed. This is accomplished on the basis of one measured criterion, dry docking scheduling, by using an integer programming model to maximise the ship's availability within the company fleet. The model is defined by three constraints: the maintenance window, maintenance completion, and the ship's limit. The model was validated using data from KOTC, and the results depict an optimum solution for maintenance scheduling, maximising the ship's availability to 100% and not less than 92%.

This cumulative dissertation is based on the hypothesis that environmental impacts arising from human activities, i.e. exploitation of natural resources, production of goods, use, and disposal, can affect different ecosystems of varying sensitivities due to global production and trade flows. In a holistic environmental assessment it would therefore be ideal to consider the whole life cycle of a product together with the ecosystems affected. Life cycle assessment (LCA) is the dominant method for assessing the environmental impacts of a product or service in relation to its functional unit and designed to cover the entire life cycle. However, an LCA model is usually a simplified and abstract picture of the reality applying steady‐state, linear modeling, and respecting spatial and temporal variabilities in natural processes only to a limited extent. This dissertation therefore applies methodologies that go beyond traditional LCA by extending or combining LCA with other interdisciplinary approaches. This cumulative dissertation consists of five research articles that explore the life cycle of three future technologies while taking site‐dependent aspects into account. Since the introduction of future technologies does not depend solely on a positive environmental assessment, the economic dimension of sustainability was also examined where feasible. Articles I and II address the environmental evaluation of wood as a regional resource: first in a conceptual approach based on a systematic literature review and, second, in a case study applying life cycle assessment, comparison of ecosystems, and eco‐design principles. In article III, the benefits of avoiding food waste were investigated for a regional black currant juice production in Germany by applying material flow cost accounting and carbon footprinting. Findings were translated into monetary and ecological metrics to raise awareness and support decision making among juice producers. Articles IV and V set out the challenges of implementing electromobility in public urban transport systems. Due to high investment costs for electric busses and the lack of adequate charging infrastructure available in public spaces, it is imperative to improve the knowledge base for planning and investment decisions. Life cycle assessment and life cycle costing were used in an integrative way to evaluate mobility alternatives for a transport provider in Dresden, while an environmental impact assessment and GIS analysis of existing bus lines revealed routes with a high environmental relief potential if electromobility were to be introduced there. / Die kumulative Dissertation basiert auf der Annahme, dass Umweltauswirkungen durch menschliche Aktivitäten aufgrund globaler Produktion und Handelsströme verschiedene Ökosysteme mit unterschiedlicher Empfindlichkeit beeinflussen können, sei es durch den Abbau natürlicher Ressourcen oder durch die Produktion, Nutzung und Entsorgung von Gütern. Bei einer ganzheitlichen Umweltbewertung wäre es daher ideal, den gesamten Lebenszyklus eines Produkts zusammen mit den betroffenen Ökosystemen zu betrachten. Die Ökobilanz ist die dominierende Methode zur Bewertung der Umweltauswirkungen eines Produkts oder einer Dienstleistung in Bezug auf die funktionelle Einheit und über den gesamten Lebenszyklus. Ein Ökobilanz‐Modell ist in der Regel jedoch nur ein vereinfachtes und abstraktes Bild der Realität, das eine stationäre, lineare Modellierung anwendet und räumliche und zeitliche Variabilität in natürlichen Prozessen nur begrenzt berücksichtigt. Diese Dissertation wendet daher Methoden an, die über die traditionelle Ökobilanz hinausgehen, indem sie diese mit anderen interdisziplinären Ansätzen erweitert oder kombiniert. Die kumulative Dissertation besteht aus fünf Forschungsarbeiten, die den Lebenszyklus von drei Zukunftstechnologien unter Berücksichtigung standortabhängiger Aspekte untersuchen. Da die Einführung von Zukunftstechnologien nicht nur von einer positive Umweltbewertung abhängt, wurde auch die wirtschaftliche Dimension der Nachhaltigkeit untersucht, wo dies sinnvoll und möglich war. Artikel I und II befassen sich mit der Umweltbewertung von Holz als regionaler Ressource, zum einen in einem konzeptionellen Ansatz, der auf einer systematischen Literaturrecherche basiert, und zum anderen in einer Fallstudie, in der die Ökobilanzierung, ein Vergleich von Waldökosystemen und Ökodesign‐Prinzipien parallel angewendet wurden. In Artikel III wurden die Vorteile der Vermeidung von Lebensmittelabfällen für eine regionale Produktion von Johannisbeersaft in Deutschland unter Anwendung der Materialflusskostenanalyse und des Kohlendioxid(CO2)‐Fußabdrucks untersucht. Die Ergebnisse wurden in monetäre und ökologische Kennzahlen umgesetzt, um das Bewusstsein zu schärfen und die Entscheidungsfindung bei den Fruchtsaftherstellern zu unterstützen. In Artikel IV und V werden die Herausforderungen bei der Umsetzung der Elektromobilität in öffentlichen Nahverkehrssystemen dargestellt. Aufgrund der hohen Investitionskosten für Elektrobusse und fehlender Ladeinfrastruktur im öffentlichen Raum ist es unerlässlich, die Wissensbasis für Planungs‐ und Investitionsentscheidungen zu verbessern. Die Ökobilanz und die Lebenszykluskostenrechnung wurden zur Bewertung von Mobilitätsalternativen für einen Verkehrsdienstleister in Dresden eingesetzt. Eine zusätzlich durchgeführte lokale Umweltverträglichkeitsprüfung bestehender Buslinien ergab ein hohes Umweltentlastungspotenzial, wenn Elektromobilität eingeführt würde.

Introduction. L’ostéoporose est une maladie chronique silencieuse jusqu’à la survenue de fractures de fragilisation, qui sont des prédicteurs importants de récurrence de fractures. La prise en charge des fractures de fragilisation au moyen de traitements de prévention secondaire des fractures est sous-optimale dans la population. Dans le but de pallier à cet écart dans les soins, de multiples initiatives de prévention secondaire des fractures ont été étudiées. Ces services ont souvent un niveau d’intervention de faible intensité et/ou un accès à des soins à court terme. Objectifs. Cette thèse comprend quatre volets liés à l’implantation d’un Service de Liaison pour Fractures (FLS) de haute intensité d’intervention ayant un suivi systématique à long terme. Le premier objectif vise à rapporter la performance de l’intervention au moyen d’indicateurs clés. Le second objectif consiste à mesurer l’usage des traitements pour l’ostéoporose dans le FLS. Le troisième objectif est d’identifier les trajectoires de soins par la présence aux visites de suivi systématique dans le FLS. L’objectif final consiste à évaluer le rapport coût-utilité en utilisant des groupes de trajectoires de soins en comparaison à la pratique clinique usuelle. Méthodologie. Un FLS appelé le programme Lucky BoneTM a été approuvé avec un devis d’étude de cohorte prospective et implanté dans deux cliniques externes d’orthopédie en milieu hospitalier. L’intervention était multifacette ; 1) identifier les femmes et les hommes de 40 ans et plus avec une fracture ostéoporotique, 2) investiguer pour la fragilité osseuse, 3) initier un traitement préventif, et 4) intégrer les sujets à un suivi systématique de deux ans. Des données cliniques et administratives ont été collectées pour mesurer l’impact du programme. Le premier volet de cette thèse rapporte la performance du FLS. Un devis de cohorte permettait de mesurer les indicateurs clés de performance (ICPs) ; les taux d’investigation pour la densité minérale osseuse (DMO), d’initiation de traitement, de participation au suivi, et le taux d’incidence de fractures subséquentes. Les changements des valeurs sériques de biomarqueurs osseux et des scores de questionnaires sur la qualité de vie/capacité fonctionnelle/douleur étaient également mesurés au moyen de modèles à effets mixtes. Le second volet de cette thèse mesure les taux de persistance et les niveaux d’adhésion (proportion de jours couverts (PDC) > 80% = bonne adhésion) au traitement sur un et deux ans de suivi. Le troisième volet de cette thèse consiste à identifier les groupes de trajectoires de soins basées sur les fréquences des visites de suivi systématique au moyen de modélisation pour les trajectoires par group-based. Le dernier volet vise à mesurer l’impact économique de ces ii groupes de trajectoires de soins par rapport à un groupe simulé de pratique clinique usuelle, qui était modélisé au moyen d’une analyse coût-utilité et des modèles analytiques de Markov. Résultats. Des 532 participants, 85.7% étaient des femmes et l’âge moyen était de 63±11 ans. Premier volet : Les résultats de la mesure des ICPs étaient les suivants : taux d’investigation de la DMO de près de 86%, taux d’initiation de traitement de > 86%, présence à au moins une visite de suivi pour 83.6% des sujets (22.2% de présence à toutes les visites) sur deux ans, et un taux d’incidence de fractures subséquentes de 2.6 par 100 personnes-années. Les biomarqueurs osseux ont grandement diminué en seulement six mois, suggérant une inhibition de la résorption osseuse par le traitement. Une amélioration significative de la capacité fonctionnelle a été observée dans le temps (14%-64%). Second volet : Les taux de persistance au traitement sur un et deux ans étaient de 66.4% et 55.6%, respectivement. Les proportions de patients avec un PDC > 0.8 sur un et deux ans étaient de 64.2% et 62.5%, respectivement. Troisième volet : Trois groupes de trajectoires de soins ont été prédits et interprétés comme une utilisation élevée (UE, 48.4%), une utilisation intermédiaire (UI, 28.1%) et une utilisation faible (UF, 23.5%). Quatrième volet : Les ratios coût-utilités incrémentaux des groupes UE, UI et UF par rapport à la pratique clinique usuelle étaient de 3,600$, 22,000$ et 74,000$ par année de vie pondérée par la qualité gagnée, respectivement. Conclusions. Un FLS ayant une haute intensité d’intervention et un suivi systématique des patients avec une fracture de fragilisation a entrainé des taux d’investigation et de traitement élevés, un faible taux de récurrence de fractures, mais une participation au suivi qui pourrait être améliorée sur deux ans. Plus de la moitié des participants étaient toujours traités et avaient un usage optimal de ces traitements après deux ans. Près de la moitié des sujets appartenaient à un groupe de trajectoire de soins élevée, ce comportement s’avérant coût-efficace. La principale limite de ce programme de recherche est le manque d’un groupe de contrôle. Un essai pragmatique randomisé contrôlé est à envisager pour supporter ces résultats. Les pistes de recherches futures incluent l’investigation des comportements reliés à l’utilisation des soins chez les patients à haut risque de refracture, et ce, au moyen d’issues qualitatives centrées sur le patient. / Introduction. Osteoporosis is an asymptomatic chronic disease until the development of osteoporosis-related fractures. Furthermore, the occurrence of a previous fragility fracture strongly increases the risk of subsequent fractures. Given the current suboptimal management of fragility fractures in usual clinical practice, several secondary fracture prevention strategies have been studied. However, continuous access to care is typically not central to these interventions as they mostly involve only one visit to a specialized healthcare professional. Objectives. This thesis had four main objectives derived from research questions focusing on the implementation of a high-intensity Fracture Liaison Service (FLS) with a systematic follow-up of two years. The first objective was to measure the performance of the intervention using key indicators. The second objective was to report on the utilization patterns of osteoporosis drugs. The third objective was to identify trajectories of compliance to follow-up care. The last objective was to evaluate the economic impact of trajectory groups of compliance to follow-up care with respect to usual care. Methodology. An FLS intervention called the Lucky BoneTM Program was approved as a prospective cohort study and implemented in two hospital-based outpatient orthopedic clinics. The intervention encompassed four components: 1) the identification of fragility fractures in women and men aged 40 years or older, 2) the investigation for bone fragility, 3) the initiation of treatment, 4) the integration of patients to a two-year systematic follow-up. Both clinical and administrative data were collected prospectively and retrospectively to measure the impact of the intervention. The first component of this thesis reported on the performance of the FLS. A cohort study design allowed for the measuring of key performance indicators (KPIs) such as the rates of bone mineral density (BMD) investigation, treatment initiation, and follow-up participation over two years, as well as the incidence rate of subsequent fragility fractures. A secondary outcome was to longitudinally measure the change in bone biomarker levels and questionnaire scores using mixed-effect models. The second component of this work aimed to measure patterns of osteoporosis drug use with a cohort study design by reporting 1 and 2-year persistence rates and compliance levels (compliance being defined as a proportion of days covered (PDC) > 0.8). The third component of this thesis consisted in the identification of trajectory groups of compliance to follow-up care using group-based trajectory modelling (GBTM). The fourth and final component iv of this thesis was a cost-utility analysis using Markov decision analytic models to evaluate the economic impact of trajectory groups of compliance to follow-up care with respect to a usual care in a simulated cohort. Results. Of the 532 fragility fracture patients that provided informed consent, 85.7% were female and the mean age was 63±11 years. First component: The FLS intervention yielded the following KPIs: BMD results were collected in almost 86% upon ordinance in the FLS, a prescription for anti-osteoporosis therapy was handed to > 86% of participants, 83.6% of subjects attended at least one follow-up visit (22.2% attended all visits) over two years, and the subsequent fracture incidence rate was of 2.6 per 100 person-years. Biomarker levels significantly decreased after six months in the FLS, supporting the inhibition of bone resorption induced by therapy. Questionnaire scores showed significant improvement of functional capacity over time (14%-64%). Second component: The one and two-year persistence rates were 66.4% and 55.6%, respectively. The proportions of patients with a one and two-year PDC > 0.8 were 64.2% and 62.5%, respectively. Third component: Through GBTM, three follow-up compliance trajectory groups were identified and consisted of high followers (HF, 48.4%), intermediate followers (IF, 28.1%) and low followers (LF, 23.5%). Fourth component: The incremental cost-utility ratios of the HF, IF and LF trajectory groups relative to usual care were $3,600, $22,000 and $74,000 per quality-adjusted life year gained, respectively. Conclusions. A high-intensity FLS intervention with a systematic follow-up of fragility fracture patients allowed ongoing access to care over a two-year period. This resulted in high rates of investigation and treatment initiation, a low subsequent fracture rate, but follow-up participation could be improved over two years. More than half of the patients were persistent and compliant to therapy after two years. Almost half the cohort had a high compliance to follow-up care trajectory and this behaviour was found to be very cost-effective compared to usual care. The main limitation of this research program was the lack of a control group to assess effectiveness. A large pragmatic randomized controlled trial is needed to support these results. Further research should focus on understanding behaviours related to compliance to care using patient-centered outcomes, especially considering the high risk of fractures over time.