Effects of Practice Redesign on Falls Health Outcomes and Costs

描述（由申请人提供）：福尔斯是最常见和最具破坏性的老化条件之一。每年约有三分之一的老年人跌倒，其中约10%的福尔斯跌倒导致包括髋部骨折在内的重大伤害。虽然实施福尔斯预防计划可以降低跌倒率，但这种计划并不广泛，而且目前福尔斯的护理质量很差。因此，福尔斯是受护理质量缺陷影响的最重要的疾病之一，应成为质量改进工作的主要目标。拟议的研究建立在一项大型对照试验ACOVEprime的基础上，该试验在5个社区实践中进行。ACOVEprime使用ACOVE-2 Intervention来提高初级保健医生为福尔斯和尿失禁提供的护理质量。ACOVE-2实践重新设计干预包括5个组成部分：1）病例发现; 2）有效收集特定病症的临床数据; 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）医生决策支持以及医生和工作人员教育。在ACOVEprime中，ACOVE-2干预对福尔斯护理整体质量的影响是显著的。在干预组中，60%的质量指标通过，而对照组为38%，效应量为58%。然而，ACOVEprime未测量结局数据。我们建议使用ACOVEprime研究中已经收集的数据，并将这些数据与医疗保险索赔数据联系起来，这将使我们能够检查干预对健康结果（包括骨折在内的伤害性福尔斯）和具有重大临床和卫生政策重要性的成本-结果的影响。为了进行这项研究，我们组建了一个经验丰富的调查团队，他们的技能包括卫生服务研究，福尔斯的临床护理，卫生经济学，统计学和医疗保险索赔数据的使用。这项研究将由一个咨询小组指导，该小组由福尔斯干预、老年医学和质量改进方面的国家专家组成。这项拟议中的研究的意义在于测试在改变医生的行为以提高福尔斯护理质量方面的明确成功是否转化为改善的临床结果和降低的医疗保健成本。如果这种联系是有效的，它将为通过以病人为中心的医疗之家等工具广泛传播ACOVE- 2模式提供强有力的支持。 公共卫生相关性：每年约有1/3的老年人跌倒，其中约10%的福尔斯跌倒导致严重损伤，包括髋部骨折。在一项对照试验中，使用ACOVE-2实践重新设计干预的ACOVEprime项目与对照实践相比，福尔斯护理质量提高了58%。拟议的研究将检查护理过程中的这些改进与福尔斯结果和成本之间的联系，这将为在全国范围内将这种做法重新设计干预传播到初级保健提供强有力的支持。

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.