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Effect of a falls quality improvement program on serious fall-related injuries
David A Ganz1, Sung-Bou Kim, David S Zingmond
1Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California.
Objectives:
To determine whether a program that improves the quality of care for falls reduces the number of episodes of care for serious fall-related injuries.
Design:
Nonrandomized controlled trial.
Setting:
Four community-based primary care practices.
Participants:
Individuals aged 75 and older who screened positive for fall risk.
Intervention:
A multicomponent quality improvement program (Assessing Care of Vulnerable Elders Practice Redesign for Improved Medical Care for Elders) involving face-to-face clinician education about falls and decision support to prompt primary care providers to implement appropriate care, including referral to appropriate community resources, in response to individuals screening positive for fall risk.
Measurements:
Episodes of care for selected fall-related injuries, based on healthcare claims.
Results:
Of 1,791 individuals with data available for analysis, 1,187 were in the intervention group, and 604 were in the control group. Mean age was 83, and more than two-thirds of the sample were women. After adjusting for potential confounders, there were no statistically significant differences between intervention and control groups in episodes of care for fall-related injuries during the 12-month (incidence rate ratio (IRR) 1.27, 95% confidence interval (CI) = 0.93-1.73) or 24-month (IRR 1.18, 95% CI = 0.93-1.49) period after initiation of the intervention.
Conclusion:
Despite improving the care of falls, this quality improvement initiative did not result in a change in the number of episodes of care for serious fall-related injuries. Future work in community-based settings should test higher-intensity interventions to reduce fall-related injuries.
