title: Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system.
abstract: BACKGROUND
  Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development.
  
  
  METHODS
  We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement.
  
  
  RESULTS
  The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it.
  
  
  CONCLUSIONS
  A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.
authors.affiliation: VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA. David.Ganz@va.gov
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated; D019317:Evidence-Based Medicine; D005260:Female; D006284:Health Plan Implementation; D006299:Health Services for the Aged / Q000592:standards*; D006787:Hospitals, Veterans; D006801:Humans; D015141:Los Angeles; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards