Effect of Dissemination of Evidence in Reducing Injuries from Falls
TINETTI et al / 2008 / Full Text (siehe Link unten):
Fall-related injuries are among the most common, morbid, and expensive health conditions involving older adults.1-5
Falls account for 10% of emergency department visits and 6% of
hospitalizations among persons over the age of 65 years and are major
determinants of functional decline, nursing-home placement, and
restricted activity.6-9
The rate of falling rises after the age of 70 years.1,2,4 Several factors — such as postural hypotension, the use of multiple medications, and impairments in cognition, vision, balance, gait, and strength — increase the risk of falling and fall injuries.1,2,4,5 Risk increases as the number of these factors increases.1,4,5 Randomized, controlled trials support the effectiveness of multicomponent fall-prevention strategies in reducing these risks.10,11
The voluntary Physician Quality Reporting Initiative (PQRI) of the Centers for Medicare and Medicaid Services (CMS) includes an assessment for the risk of falls.12 The Joint Commission on the accreditation of health care organizations and the Medicare Payment Advisory Commission mandate attention to the prevention of falls.13,14
Despite evidence and mandates, falls remain largely ignored in clinical practice.15 Furthermore, data are lacking on whether fall prevention is effective in the fragmented environment in which older Americans receive their health care. The components of the assessment and management of fall-related risk factors are under the purview of physicians, rehabilitation specialists, home care agencies, and other clinicians practicing in different settings under varying incentives and reimbursement mechanisms.16 Several groups have called for improving the transfer of evidence from randomized, controlled trials into practice.17-19 Reported barriers to incorporating evidence about fall prevention into practice include ignorance about falling as a preventable condition, competing time demands, a perceived lack of expertise, insufficient reimbursement, and inadequate referral patterns among clinicians. Factors that were reported to facilitate fall prevention included efforts to market new services and to develop referral networks.16,20
The Connecticut Collaboration for Fall Prevention (CCFP) encouraged clinicians and facilities to incorporate evidence from the Yale-based Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) study and other trials into their practice.10,11,20-25 The aim of our study was to compare the rates of serious fall-related injuries and the fall-related use of medical services among persons who were 70 years of age or older in the CCFP intervention and usual-care regions.
The rate of falling rises after the age of 70 years.1,2,4 Several factors — such as postural hypotension, the use of multiple medications, and impairments in cognition, vision, balance, gait, and strength — increase the risk of falling and fall injuries.1,2,4,5 Risk increases as the number of these factors increases.1,4,5 Randomized, controlled trials support the effectiveness of multicomponent fall-prevention strategies in reducing these risks.10,11
The voluntary Physician Quality Reporting Initiative (PQRI) of the Centers for Medicare and Medicaid Services (CMS) includes an assessment for the risk of falls.12 The Joint Commission on the accreditation of health care organizations and the Medicare Payment Advisory Commission mandate attention to the prevention of falls.13,14
Despite evidence and mandates, falls remain largely ignored in clinical practice.15 Furthermore, data are lacking on whether fall prevention is effective in the fragmented environment in which older Americans receive their health care. The components of the assessment and management of fall-related risk factors are under the purview of physicians, rehabilitation specialists, home care agencies, and other clinicians practicing in different settings under varying incentives and reimbursement mechanisms.16 Several groups have called for improving the transfer of evidence from randomized, controlled trials into practice.17-19 Reported barriers to incorporating evidence about fall prevention into practice include ignorance about falling as a preventable condition, competing time demands, a perceived lack of expertise, insufficient reimbursement, and inadequate referral patterns among clinicians. Factors that were reported to facilitate fall prevention included efforts to market new services and to develop referral networks.16,20
The Connecticut Collaboration for Fall Prevention (CCFP) encouraged clinicians and facilities to incorporate evidence from the Yale-based Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) study and other trials into their practice.10,11,20-25 The aim of our study was to compare the rates of serious fall-related injuries and the fall-related use of medical services among persons who were 70 years of age or older in the CCFP intervention and usual-care regions.
Methods
Setting and Design
We used a nonrandomized design to compare two regions in Connecticut.26 We chose ZIP Code tabulation areas (ZCTAs; bounded areas that correspond to ZIP Codes) as the experimental units to maintain the anonymity of persons living in the regions while ensuring an adequate number of sampling units.27 Anonymity was necessary because informed consent was not feasible. Clinicians and facilities in the two regions were identified through professional-licensing databases operated by the Connecticut Department of Public Health. Other than the CCFP project, there were no coordinated fall-prevention efforts under way before or during the study period in either the intervention region or the usual-care region. The study was approved by the Human Investigation Committee at Yale School of Medicine. The committee understood and agreed that informed consent was not required from the participating practitioners and patients.Quelle: http://www.nejm.org/doi/full/10.1056/NEJMoa0801748#t=articleResults
Online m internet 09.10.2012
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Labels: Baden-Baden, Effect of Dissemination of Evidence in Reducing Injuries from Falls, Prävention, Training
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