title: Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.
abstract: Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored.
  
  
  
  This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios.
  
  
  
  To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings.
  
  
  
  ClinicalTrials.gov ( NCT02487589 ).
authors.affiliation: Operative Unit for Recovery and Functional Rehabilitation, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Via Giuseppe Mazzini, 129, 25065, Lumezzane (Brescia), Italy. alessandro.giordano@fsm.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Operative Unit for Recovery and Functional Rehabilitation, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Via Giuseppe Mazzini, 129, 25065, Lumezzane (Brescia), Italy.
authors.forename: Gian Pietro
authors.initials: GP
authors.lastname: Bonometti
authors.affiliation: Neurological Rehabilitation, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Brescia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vanoglio
authors.affiliation: Cardiac Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Brescia, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Paneroni
authors.affiliation: Telemedicine Service, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Brescia, Italy.
authors.forename: Palmira
authors.initials: P
authors.lastname: Bernocchi
authors.affiliation: Health Directorate, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Comini
authors.affiliation: Cardiac Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (Brescia), Brescia, Italy.
authors.forename: Amerigo
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D003362:Cost-Benefit Analysis; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007558:Italy; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000592:standards*; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D011788:Quality of Life; D012107:Research Design; D018570:Risk Assessment / Q000379:methods / Q000458:organization & administration; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration
keywords: Cost-effectiveness; Fall; Information Communication Technologies; Prevention; Trial