Effects of Practice Redesign on Falls Health Outcomes and Costs

实践重新设计对跌倒健康结果和成本的影响

基本信息

批准号：
8313977
负责人：
DAVID B. REUBEN
金额：
$ 30.96万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8313977
关键词：
Affect Aging American College of Physicians Behavior Caring Characteristics Clinical Clinical Data Clinical Trials Collection Communities Control Groups Cost Effectiveness Analysis Data Dialysis procedure Education Effectiveness Effectiveness of Interventions Elderly Equilibrium Fall prevention Family Fracture Gait Geriatrics Health Health Care Costs Health Policy Health Services Health Services Research Heart Diseases Hip Fractures Home environment Injury Intervention Learning Link Lipids Medical Medical Records Medicare claim Modeling Outcome Outcome Measure Participant Patients Physical therapy exercises Physicians Policies Prevention program Primary Care Physician Primary Health Care Process Process Measure Public Health Quality Indicator Quality of Care Recruitment Activity Research Research Personnel Resources Sampling Screening for cancer Series Testing Translating Urinary Incontinence Work abstracting adverse outcome case finding clinical care community based practice compare effectiveness control trial cost cost effective experience falls fear of falling group intervention health economics improved interdisciplinary approach intervention effect meetings multidisciplinary patient oriented prevent programs public health relevance skills statistics success successful intervention treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Falls are among the most common and most devastating conditions of aging. Each year approximately 1/3 of older adults fall and approximately 10% of these falls result in major injuries including hip fractures. Although the implementation of falls prevention programs can reduce fall rates, such programs are not widely available and the current quality of care of falls is poor. Thus, falls are among the most important conditions affected by deficits in quality of care and should be a major target for quality improvement efforts. The proposed research builds upon a large controlled trial, ACOVEprime, conducted at 5 community-based practices. ACOVEprime used the ACOVE-2 Intervention to improve the quality of care that primary care physicians provide for falls and urinary incontinence. The ACOVE-2 practice redesign intervention includes 5 components: 1) case finding; 2) efficient collection of condition-specific clinical data; 3) medical record prompts; 4) patient and family education materials, including linkages to community resources; and 5) physician decision support and physician and staff education. In ACOVEprime, the effect of the ACOVE-2 Intervention on the overall quality of falls care was dramatic. In the intervention group, 60% of quality indicators were passed compared to 38% in the control group, a 58% effect size. However, ACOVEprime did not measure outcome data. We propose to use data already collected in the ACOVEprime study and link these data to Medicare claims data, which will enable us to examine the effects of the intervention on health outcomes (injurious falls including fractures) and costs-outcomes of great clinical and health policy importance. To conduct this research, we have assembled an experienced team of investigators whose skills include health services research, clinical care of falls, health economics, statistics, and use of Medicare claims data. The study will be guided by an Advisory Panel consisting national experts in falls interventions, geriatrics, and quality improvement. The proposed study's significance lies in testing whether the unequivocal success in changing physicians' behavior to improve quality of care for falls translates into improved clinical outcomes and decreased health care costs. If this linkage is valid, it would provide strong support for widespread dissemination of the ACOVE- 2 model through vehicles such as the Patient-Centered Medical Home. PUBLIC HEALTH RELEVANCE: Each year approximately 1/3 of older adults fall and approximately 10% of these falls result in major injuries including hip fractures. In a controlled trial, the ACOVEprime project using the ACOVE-2 practice redesign intervention resulted in a 58% improvement in the quality of falls care compared to control practices. The proposed study will examine the linkages between these improvements in process of care and falls outcomes and costs, which will provide strong support for dissemination of this practice redesign intervention into primary care nationwide.

描述（由申请人提供）：跌倒是衰老的最常见和最具破坏性的条件之一。每年约有1/3的老年人跌倒，其中约10％的跌倒会导致重大伤害，包括髋部骨折。尽管预防跌倒计划的实施可以降低跌倒率，但此类计划并未广泛使用，并且目前的跌倒护理质量很差。因此，跌倒是受护理质量不足影响的最重要条件之一，应该是改进质量努力的主要目标。拟议的研究基于一项大型对照试验AcovePrime，该试验以5种基于社区的实践进行。 AcovePrime使用ACOVE-2干预措施来提高初级保健医生为跌倒和尿失禁提供的护理质量。 ACOVE-2练习重新设计干预措施包括5个组件：1）案例查找； 2）有效收集特定条件的临床数据； 3）病历提示； 4）患者和家庭教育材料，包括与社区资源的联系； 5）医师的决策支持以及医师和员工教育。在AcovePrime中，ACOVE-2干预对瀑布护理整体质量的影响是巨大的。在干预组中，对照组的质量指标的60％被通过，效果大小为58％。但是，AcovePrime并未衡量结果数据。我们建议使用在AcovePrime研究中收集的数据，并将这些数据与Medicare索赔数据联系起来，这将使我们能够检查干预对健康结果的影响（包括骨折在内的有害跌倒）和临床和健康政策重要的成本范围。为了进行这项研究，我们组建了一支经验丰富的研究人员团队，其技能包括卫生服务研究，跌倒，健康经济学，统计数据以及Medicare索赔数据的使用。这项研究将由咨询小组的指导，该咨询小组在秋季干预，老年医学和质量改进方面的全国专家组成。拟议的研究的意义在于测试在改变医师行为方面的明确成功以改善瀑布的护理质量，这转化为改善的临床结果和降低医疗保健成本。如果这种联系有效，它将通过以患者为中心的医疗屋等车辆来广泛地传播Acove-2模型。公共卫生相关性：每年约有1/3的老年人跌倒，其中约10％的跌倒会导致重大伤害，包括髋部骨折。在一项对照试验中，使用ACOVE-2实践重新设计干预措施的ACOVEPRIME项目与对照实践相比，跌倒护理质量提高了58％。拟议的研究将研究这些在护理过程中的改进与跌倒结果和成本之间的联系，这将为全国初级保健重新设计干预提供大力支持。