Implementation and Assessment of a Fall Screening Program in Primary Care Practices
Implementation and Assessment of a Fall Screening Program in Primary Care Practices
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DOI：
10.1111/jgs.13137
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发表时间：
2014-12-01
影响因子：
6.3
通讯作者：
Galvin, Shelley L.
中科院分区：
文献类型：
--
作者：
Landis, Suzanne E.;Galvin, Shelley L.
老年人跌倒预防策略在初级保健中未得到充分利用。一项研究旨在检查医疗保险和医疗补助服务中心医师质量报告系统（PQRS）的跌倒措施，并将跌倒造成的伤害和成本减少10%。该质量改进项目采用前后设计，在北卡罗来纳州阿什维尔的四个初级保健实践中实施，共有2021名65岁及以上的患者。该项目使用了患者登记、电子模板、标准化护理方案、跌倒诊所来评估报告跌倒的个人，以及患者资源材料。从医疗记录中收集有关护理过程、跌倒相关伤害和预期付款的数据。2011年7月至2012年6月期间至少有一次门诊就诊的个人（n=2,021）构成了干预队列，并分析了需要住院治疗的跌倒损伤(干预前（T1）： 2010年7月至2011年3月；干预后（T2）： 2012年7月至2013年3月。实践场所对68.8%的老年人进行了适当的跌倒筛查，对87%的报告跌倒的人进行了评估，并对23%的老年人的PQRS要求的护理计划进行了记录。只有20%的人自我报告下降。需要去医院的跌倒次数总体上较少，没有减少（T1, 2.4%; T2, 2.9%； P= 0.32）；在医院因跌倒相关伤害就诊的个人中，61%没有报告过先前的跌倒。将PQRS跌倒测量纳入初级保健是具有挑战性的，而且该计划不够强大，无法减少严重跌倒和医院费用。
Fall prevention strategies for older adults are underused in primary care. A study was designed to examine the Centers for Medicare and Medicaid Services Physician Quality Reporting System (PQRS) fall measures and to reduce injuries and costs from falls by 10%. This quality improvement project using a pre/post design was implemented in four primary care practices with 2,021 patients aged 65 and older in Asheville, North Carolina. The project used a patient registry, electronic templates, standardized care protocols, a falls clinic to evaluate individuals who reported falling, and patient resource materials. Data were collected from medical records on processes of care, fall-related injuries, and anticipated payments. Individuals billed for at least one outpatient visit from July 2011 through June 2012 (n=2,021) constituted the cohort for the intervention and for analysis of injuries from falls requiring hospital visits (before the intervention (T1): July 2010 to March 2011; after the intervention (T2): July 2012 to March 2013). Practice sites properly screened 68.8% of older adults for falls, assessed 87% of those who reported falling, and documented the PQRS required plan of care in 23%. Only 20% self-reported falls. Numbers of falls requiring a visit to the hospital were small overall and did not decrease (T1, 2.4%; T2, 2.9%; P=.32); 61% of individuals seen in the hospital for fall-related injuries had not reported previous falls. Incorporating the PQRS fall measures into primary care was challenging, and the program was not robust enough to reduce serious falls and hospital costs.