Translating evidence-based falls prevention into clinical practice in nursing facilities: Results and lessons from a quality improvement collaborative.
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.
Colón-Emeric
Cathleen
C
Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA. colon001@mc.duke.edu
Schenck
Anna
A
Gorospe
Joel
J
McArdle
Jill
J
Dobson
Lee
L
Deporter
Cindy
C
McConnell
Eleanor
E
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