"While the Australian program included bone health assessment, the Colombian program included more comprehensive fall risk screening tools in their assessment. The initial assessment at both clinics consists of a comprehensive fall risk assessment, including a structured algorithm adapted from the Assessing Care of Vulnerable Elders (ACOVE) intervention to identify risk factors for falls.23 Recommendations for management are generated at an interdisciplinary meeting. "
[Show abstract][Hide abstract] ABSTRACT: Falls and fractures are major causes of morbidity and mortality in older people. More importantly, previous falls and/or fractures are the most important predictors of further events. Therefore, secondary prevention programs for falls and fractures are highly needed. However, the question is whether a secondary prevention model should focus on falls prevention alone or should be implemented in combination with fracture prevention. By comparing a falls prevention clinic in Manizales (Colombia) versus a falls and fracture prevention clinic in Sydney (Australia), the objective was to identify similarities and differences between these two programs and to propose an integrated model of care for secondary prevention of fall and fractures. A comparative study of services was performed using an internationally agreed taxonomy. Service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE) and previous reports in the literature. Comparison included organization, administration, client characteristics, and interventions. Several similarities and a number of differences that could be easily unified into a single model are reported here. Similarities included population, a multidisciplinary team, and a multifactorial assessment and intervention. Differences were eligibility criteria, a bone health assessment component, and the therapeutic interventions most commonly used at each site. In Australia, bone health assessment is reinforced whereas in Colombia dizziness assessment and management is pivotal. The authors propose that falls clinic services should be operationally linked to osteoporosis services such as a "falls and fracture prevention clinic," which would facilitate a comprehensive intervention to prevent falls and fractures in older persons.
"The evaluation will also review patients' medical records to assess how well the pilot program is being implemented, as well as the overall quality of care patients received for fall prevention. Medical record review will use quality indicators for care of vulnerable older adults with falls and mobility disorders , for which benchmark data from non-VA sites are available . Given the incremental approach we have taken, we do not expect the evaluation of the first iteration of the Telecare fall prevention program to demonstrate uniformly positive findings, but do think it will yield more concrete areas for improvement efforts. "
[Show abstract][Hide abstract] ABSTRACT: Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development.
We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement.
The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it.
A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.
BMC Health Services Research 11/2009; 9(1):206. DOI:10.1186/1472-6963-9-206 · 1.71 Impact Factor
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