Effect of dissemination of evidence in reducing injuries from falls

Abstract

Background: Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.

Methods: Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006.

Results: Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies).

Conclusions: Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.

Figure 1. Intervention and Usual-Care Regions for the Connecticut Collaboration for Fall Prevention

The intervention region included 58 ZIP Code tabulation areas (ZCTAs) encompassing Hartford and surrounding towns. The usual-care region (blue) comprised 53 ZCTAs that excluded an area in which some Medicare beneficiaries received care from the same clinicians as those in the intervention area (green).

Figure 2. Proportion of Facilities in the Intervention Region That Received at Least One Outreach Visit

All facilities in these groups (number in parentheses) were contacted. The proportion that accepted visits by members of an intervention team are shown. Most visits occurred before October 2004, although a few additional visits to home care agencies, rehabilitation facilities, and senior centers occurred through July 2006.

Figure 3. Adjusted Annual Rates of Serious Fall-Related Injuries and Use of Medical Services per 1000 Persons 70 Years of Age or Older during the Preintervention, Intervention, and Evaluation Periods

Panel A shows the rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations), and Panel B shows the fall-related use of medical services, including all emergency department visits or hospitalizations with a fall-related E-code. The rates were adjusted for spatial variability, the baseline rate of falls or serious injuries, age, sex, race, income, and the proportion of persons over the age of 65 years who were institutionalized or disabled. The bars represent 95% credibility intervals (CIs). Adjusted rate ratios were estimated as the adjusted rates of serious fall-related injuries or use of medical services in the intervention region divided by those in the usual-care region.