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Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative.

Publication ,  Journal Article
Colón-Emeric, C; Schenck, A; Gorospe, J; McArdle, J; Dobson, L; Deporter, C; McConnell, E
Published in: J Am Geriatr Soc
September 2006

OBJECTIVES: To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities. DESIGN: Natural experiment with nonparticipating facilities serving as controls. SETTING: Community nursing homes. PARTICIPANTS: Thirty-six participating and 353 nonparticipating nursing facilities in North Carolina. INTERVENTION: Two in-person learning sessions, monthly teleconferences, and an e-mail discussion list over 9 months. The change package emphasized screening, labeling, and risk-factor reduction. MEASUREMENTS: Compliance was measured using facility self-report and chart abstraction (n = 832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome. RESULTS: Self-reported compliance with screening, labeling, and risk-factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P < .05), risk-factor reduction (4% to 7%, P = .30), and medication assessment (2% to 6%, P = .34). There was a significant increase in vitamin D prescriptions (40% to 48%, P=.03) and decrease in sedative-hypnotics (19% to 12%, P = .04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P = .17), MDS (18.2% to 15.4%, P = .56), or self-report (6.1-5.6 falls/1,000 bed days, P = .31). CONCLUSION: Multiple-risk-factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real-world setting. Substantial differences between self-reported practice and medical record documentation require that additional data sources be used to assess the change-in-care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed.

Duke Scholars

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

September 2006

Volume

54

Issue

9

Start / End Page

1414 / 1418

Location

United States

Related Subject Headings

  • Quality Assurance, Health Care
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Nursing Homes
  • North Carolina
  • Male
  • Humans
  • Guideline Adherence
  • Geriatrics
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Colón-Emeric, C., Schenck, A., Gorospe, J., McArdle, J., Dobson, L., Deporter, C., & McConnell, E. (2006). Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. J Am Geriatr Soc, 54(9), 1414–1418. https://doi.org/10.1111/j.1532-5415.2006.00853.x
Colón-Emeric, Cathleen, Anna Schenck, Joel Gorospe, Jill McArdle, Lee Dobson, Cindy Deporter, and Eleanor McConnell. “Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative.J Am Geriatr Soc 54, no. 9 (September 2006): 1414–18. https://doi.org/10.1111/j.1532-5415.2006.00853.x.
Colón-Emeric C, Schenck A, Gorospe J, McArdle J, Dobson L, Deporter C, et al. Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. J Am Geriatr Soc. 2006 Sep;54(9):1414–8.
Colón-Emeric, Cathleen, et al. “Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative.J Am Geriatr Soc, vol. 54, no. 9, Sept. 2006, pp. 1414–18. Pubmed, doi:10.1111/j.1532-5415.2006.00853.x.
Colón-Emeric C, Schenck A, Gorospe J, McArdle J, Dobson L, Deporter C, McConnell E. Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative. J Am Geriatr Soc. 2006 Sep;54(9):1414–1418.
Journal cover image

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

September 2006

Volume

54

Issue

9

Start / End Page

1414 / 1418

Location

United States

Related Subject Headings

  • Quality Assurance, Health Care
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Nursing Homes
  • North Carolina
  • Male
  • Humans
  • Guideline Adherence
  • Geriatrics
  • Female