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.
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
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Labels: Baden-Baden, Effect of Dissemination of Evidence in Reducing Injuries from Falls, Prävention, Training
