Translating a Multifactorial Fall Prevention Intervention into Practice: A Controlled Evaluation of a Fall Prevention Clinic

Authors

  • Meghann Moore MPH, RD,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • Barbara Williams PhD,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • Sally Ragsdale ARNP, BSN, MN,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • James P. LoGerfo MD, MPH,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • J. Richard Goss MD, MPH,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • Astrid B. Schreuder PhD,

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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  • Elizabeth A. Phelan MD, MS

    1. From the *Divisions of Gerontology and Geriatric Medicine, Cardiology, and §General Internal Medicine, Department of Medicine and Health Promotion Research Center, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; and Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
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Address correspondence to Elizabeth A. Phelan, Department of Medicine/Division of Gerontology and Geriatric Medicine, 325 9th Avenue, Box 359755, Seattle, WA 98104. E-mail: phelane@u.washington.edu

Abstract

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital-based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age-, sex-, and race-matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall-related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow-up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall-related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow-up; differences in fall-related healthcare use according to study group from baseline to follow-up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real-world clinical practice settings on key outcomes, including injurious falls, downstream fall-related healthcare use, and costs.

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