Practice redesign to improve care for falls and urinary incontinence: primary care intervention for older patients.
BACKGROUND
In primary care, medical care for age-associated conditions, such as falls and urinary incontinence (UI), is inadequate. In collaboration with the American College of Physicians, we augmented the Assessing Care of Vulnerable Elders practice redesign intervention to improve falls and UI care.


METHODS
We performed a controlled trial in 5 nonrandomly selected primary care intervention (26 physicians across sites) and control (18 physicians) practices from diverse communities. Patients 75 years and older who screened positive for falls or fear of falling and UI were included in the study. We conducted a multicomponent intervention between October 30, 2006, and December 31, 2007, that included efficient collection of data, medical record prompts, patient education materials, and physician decision support. Main outcome measures were quality of care for falls and UI comparing intervention and control sites.


RESULTS
Of 6051 patients screened, 2847 (47.1%) screened positive for falls or UI (46.1% in the intervention group and 48.8% in the control group). Across the 5 practices, 1211 patient medical records were evaluated after stratified random selection. Intervention patients received 60.0% of recommended care for falls vs 37.6% provided by control health care professionals (P < .001). Similarly, intervention health care professionals provided more recommended care for UI (47.2% vs 27.8%, P < .001). Intervention health care professionals more often performed a falls history, orthostatic blood pressure measurement, gait and balance examination, and UI history and tried UI behavioral treatments first. Knowledge about falls and UI increased more among intervention than control group health care professionals.


CONCLUSIONS
Practice redesign can improve the care that community-based primary care physicians provide for older patients with falls and UI. Outcomes of such care improvements require further evaluation.
Wenger
Neil S
NS
University of California, Los Angeles, 90024, USA. nwenger@mednet.ucla.edu
Roth
Carol P
CP
Hall
William J
WJ
Ganz
David A
DA
Snow
Vincenza
V
Byrkit
James
J
Dzielak
Edward
E
Gullen
David J
DJ
Loepfe
Thomas R
TR
Sahler
Carl
C
Snooks
Qianna
Q
Beckman
Robin
R
Adams
John
J
Rosen
Mayde
M
Reuben
David B
DB
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000639:trends*; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control*