title: A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia.
abstract: 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.
authors.affiliation: RAND, Santa Monica, California, USA. nwenger@mednet.ucla.edu
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Carol P
authors.initials: CP
authors.lastname: Roth
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
authors.forename: Roy T
authors.initials: RT
authors.lastname: Young
authors.forename: David H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Caren J
authors.initials: CJ
authors.lastname: Kamberg
authors.forename: John T
authors.initials: JT
authors.lastname: Chang
authors.forename: Rachel
authors.initials: R
authors.lastname: Louie
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higashi
authors.forename: Catherine H
authors.initials: CH
authors.lastname: MacLean
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Lillian C
authors.initials: LC
authors.lastname: Min
authors.forename: Kurt
authors.initials: K
authors.lastname: Ransohoff
authors.forename: Marc
authors.initials: M
authors.lastname: Hoffing
authors.forename: David B
authors.initials: DB
authors.lastname: Reuben
mesh_terms: 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*