title: CONNECT for better fall prevention in nursing homes: results from a pilot intervention study.
abstract: OBJECTIVE
  To determine whether an intervention that improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS).
  
  
  METHODS
  Cluster randomized trial.
  
  
  METHODS
  Community (n=4) and Veterans Affairs (VA) NHs (n=4).
  
  
  METHODS
  Staff in any role with resident contact (n=497).
  
  
  METHODS
  NHs received FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3 months. CONNECT used storytelling, relationship mapping, mentoring, self-monitoring, and feedback to help staff identify communication gaps and practice interaction strategies. FALLS included group training, modules, teleconferences, academic detailing, and audit and feedback.
  
  
  METHODS
  NH staff completed surveys about interactions at baseline, 3 months (immediately after CONNECT or control period), and 6 months (immediately after FALLS). A random sample of resident charts was abstracted for fall risk reduction documentation (n=651). Change in facility fall rates was an exploratory outcome. Focus groups were conducted to explore changes in organizational learning.
  
  
  RESULTS
  Significant improvements in staff perceptions of communication quality, participation in decision-making, safety climate, caregiving quality, and use of local interaction strategies were observed in intervention community NHs (treatment-by-time effect P=.01) but not in VA NHs, where a ceiling effect was observed. Fall risk reduction documentation did not change significantly, and the direction of change in individual facilities did not relate to observed direction of change in fall rates. Fall rates did not change in control facilities (falls/bed per year: baseline, 2.61; after intervention, 2.64) but decreased by 12% in intervention facilities (falls/bed per year: baseline, 2.34; after intervention, 2.06); the effect of treatment on rate of change was 0.81 (95% confidence interval=0.55-1.20).
  
  
  CONCLUSIONS
  CONNECT has the potential to improve care delivery in NHs, but the trend toward improving fall rates requires confirmation in a larger ongoing study.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.|Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina.
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colon-Emeric
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.|Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina.|School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.
authors.forename: Sandro O
authors.initials: SO
authors.lastname: Pinheiro
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.
authors.forename: Kristie
authors.initials: K
authors.lastname: Porter
authors.affiliation: KayeM, Inc., Durham, North Carolina.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Earp
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.|School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Landerman
authors.affiliation: Richmond Veterans Affairs Medical Center, Richmond, Virginia.
authors.forename: Julie
authors.initials: J
authors.lastname: Beales
authors.affiliation: KayeM, Inc., Durham, North Carolina.|Salem Veterans Affairs Medical Center, Salem, Virginia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Asheville Veterans Affairs Medical Center, Asheville, North Carolina.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hancock
authors.affiliation: Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.|School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D014768:Virginia
keywords: accidental falls; nursing homes; staff education