A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia.
OBJECTIVE
To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment.


METHODS
Controlled trial.


METHODS
Two community medical groups.


METHODS
Community-dwelling patients (357 at intervention sites and 287 at control sites) aged 75 and older identified as having difficulty with falls, incontinence, or cognitive impairment.


METHODS
Intervention and control practices received condition case-finding, but only intervention practices received a multicomponent practice-change intervention.


METHODS
Percentage of quality indicators satisfied measured using a 13-month medical record abstraction.


RESULTS
Before the intervention, the quality of care was the same in intervention and control groups. Screening tripled the number of patients identified as needing care for falls, incontinence, or cognitive impairment. During the intervention, overall care for the three conditions was better in the intervention than the control group (41%, 95% confidence interval (CI)=35-46% vs 25%, 95% CI=20-30%, P<.001). Intervention group patients received better care for falls (44% vs 23%, P<.001) and incontinence (37% vs 22%, P<.001) but not for cognitive impairment (44% vs 41%, P=.67) than control group patients. The intervention was more effective for conditions identified by screening than for conditions identified through usual care.


CONCLUSIONS
A practice-based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence, although even with the intervention, less than half of the recommended care for these conditions was provided. More-intensive interventions, such as embedding intervention components into an electronic medical record, will be needed to adequately improve care for falls and incontinence.
Wenger
Neil S
NS
RAND, Santa Monica, California, USA. nwenger@mednet.ucla.edu
Roth
Carol P
CP
Shekelle
Paul G
PG
Young
Roy T
RT
Solomon
David H
DH
Kamberg
Caren J
CJ
Chang
John T
JT
Louie
Rachel
R
Higashi
Takahiro
T
MacLean
Catherine H
CH
Adams
John
J
Min
Lillian C
LC
Ransohoff
Kurt
K
Hoffing
Marc
M
Reuben
David B
DB
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000628:therapy*; D004502:Education, Medical, Continuing; D004526:Efficiency; D005260:Female; D005853:Geriatrics / Q000193:education*; D006801:Humans; D015141:Los Angeles; D008297:Male; D008403:Mass Screening / Q000592:standards; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D014549:Urinary Incontinence / Q000628:therapy*