title: Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative.
abstract: OBJECTIVE
  To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities.
  
  
  METHODS
  Natural experiment with nonparticipating facilities serving as controls.
  
  
  METHODS
  Community nursing homes.
  
  
  METHODS
  Thirty-six participating and 353 nonparticipating nursing facilities in North Carolina.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA. colon001@mc.duke.edu
authors.forename: Cathleen
authors.initials: C
authors.lastname: Colón-Emeric
authors.forename: Anna
authors.initials: A
authors.lastname: Schenck
authors.forename: Joel
authors.initials: J
authors.lastname: Gorospe
authors.forename: Jill
authors.initials: J
authors.lastname: McArdle
authors.forename: Lee
authors.initials: L
authors.lastname: Dobson
authors.forename: Cindy
authors.initials: C
authors.lastname: Deporter
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000368:Aged; D003299:Cooperative Behavior; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009657:North Carolina; D009735:Nursing Homes; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care