Dissemination of an Evidence-Based Multicomponent Fall Risk-Assessment and -Management Strategy Throughout a Geographic Area

doi:10.1111/j.1532-5415.2005.53218.x

If you are seeing this message, you may be experiencing temporary network problems. Please wait a few minutes and refresh the page. If the problem persists, you may wish to report it to your local Network Manager.

It is also possible that your web browser is not configured or not able to display style sheets. In this case, although the visual presentation will be degraded, the site should continue to be functional. We recommend using the latest version of Microsoft or Mozilla web browser to help minimise these problems.

Wiley InterScience

Journal of the American Geriatrics Society

Volume 53 Issue 4, Pages 675 - 680

Published Online: 30 Mar 2005

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

Published on behalf of

Go to Society Site

< Previous Abstract | Next Abstract >

Save Article to My Profile Download Citation Request Permissions

Abstract | References | Full Text: HTML, PDF (Size: 84K) | Related Articles | Citation Tracking

Dissemination of an Evidence-Based Multicomponent Fall Risk-Assessment and -Management Strategy Throughout a Geographic Area

Dorothy I. Baker, PhD, RNCS ^* , Mary B. King, MD ^‡§ , Richard H. Fortinsky, PhD ^§ , Louis G. Graff,IV, MD, FACEP, FACP ^¶ , Margaret Gottschalk, PTMS ^∥ , Denise Acampora, MPH ^† , Jeanette Preston, MD, MPH ^‡ , Cynthia J. Brown, MD ^† and Mary E. Tinetti, MD ^*†

From the Departments of ^*Epidemiology and Public Health and ^†Medicine, Yale University School of Medicine, New Haven, Connecticut; ^‡Department of Medicine, Hartford Hospital, Hartford, Connecticut; ^§Center on Aging, University of Connecticut Health Center, Farmington, Connecticut; ^∥Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Connecticut; and ^¶Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington, Connecticut

Address correspondence to Mary E. Tinetti, MD, 333 Cedar Street, PO Box 208025, New Haven, CT 06520. E-mail: mary.tinetti@yale.edu

This project was supported by a grant from the Donaghue Foundation and by the Yale Pepper Center (P60AG10469) from the National Institute on Aging.

KEYWORDS

fall prevention • elderly patients • behavioral change • disseminating research into practice

ABSTRACT

Objectives: To report on the penetration of, and identified barriers to and facilitators of, efforts to incorporate evidence-based fall risk assessment and management into clinical practice throughout a defined geographic area.

Design: Dissemination project.

Setting: North central Connecticut.

Participants: Hospitals, home care agencies, primary care providers, and outpatient rehabilitation facilities.

Intervention: Multiple professional behavior-change strategies were used to encourage providers to incorporate evidence-based fall assessment and management into their practices.

Measurements: Penetration of dissemination efforts over 36 months; barriers and facilitators identified by provider working groups during the first 2 years of the project.

Results: All seven hospitals and 26 home care agencies in the area, 119 of 130 rehabilitation facilities, and 138 of 212 primary care offices participated. Most provider working groups expressed similar barriers and facilitating factors. Reported barriers specific to fall risk management included lack of awareness of fall morbidity and preventability, perceived lack of expertise and Medicare coverage, inadequate referral patterns among providers, and lack of a federal mandate for physicians. Facilitating factors specific to falls included the opportunity to market new services and to develop new networks of professional relationships across disciplines and the Medicare mandate that home care agencies focus on functional outcomes.

Conclusion: Dissemination efforts showed notable successes as well as challenges. Although many of the barriers were general to diffusing new practices, several were specific to fall assessment and management that span disciplines and sites. Project results have implications for efforts to diffuse evidence-based practices for multifactorial geriatric conditions such as falls.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2005.53218.x About DOI