Extent of Implementation of Evidence-Based Fall Prevention Practices for Older Patients in Home Health Care

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01630.x Byline: Richard H. Fortinsky (*), Dorothy Baker ([dagger]), Margaret Gottschalk ([double dagger]), Mary King (s.), Patricia Trella (*), Mary E. Tinetti ([dagger],[parallel]) Keywords: fall prevention; home health care; risk assessment and management; disseminating research into practice Abstract: This study determined the extent to which fall risk assessment and management practices for older patients were implemented in Medicare-certified home health agencies (HHAs) in a defined geographic area in southern New England that had participated in evidence-based fall prevention training between October 2001 and September 2004. The standardized in-service training sessions taught home health nurses and rehabilitation therapists how to conduct assessments for five evidence-based risk factors for falls in older adults-mobility impairments, balance disturbances, multiple medications, postural hypotension, and home environmental hazards-using techniques shown to be efficacious in clinical trials. Twenty-six HHAs participated in these in-service training sessions; 19 of these participated in a survey of nurses and rehabilitation therapists between October 2004 and September 2005. Self-reported assessment and management practices implemented with older patients during home healthcare visits were measured in this survey, and HHA-level measures for each fall risk factor were constructed based on proportions of clinicians reporting assessment and management practices that were recommended in the fall prevention training sessions. For all fall risk factors except postural hypotension, 80% or more of clinicians in all HHAs reported implementing recommended fall risk management practices. Greater variation was found regarding fall risk assessment practices, with fewer than 70% of clinicians in one or more HHAs reporting recommended assessment practices for all risk factors. Results suggest that evidence-based training for home healthcare clinicians can stimulate fall risk assessment and management practices during home health visits. HHA-level comparisons hold the potential to illustrate the extent of diffusion of evidence-based fall prevention practices within and between agencies. Author Affiliation: (*)Center on Aging, University of Connecticut Health Center, Farmington, ConnecticutDepartments of ([dagger])Internal Medicine, Yale University School of Medicine, New Haven, Connecticut ([parallel])Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut ([double dagger])Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Connecticut (s.)Department of Medicine, Hartford Hospital, Hartford, Connecticut Article note: Address correspondence to Richard H. Fortinsky, PhD, Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030. E-mail: fortinsky@uchc.edu