A substantial number of fall risk assessment tools are readily available and assess similar patient characteristics. Although their diagnostic accuracy and overall usefulness showed wide variability, there are several scales that can be used with confidence as part of an effective falls prevention program. Consequently, there should be little need for facilities to develop their own scales. To continue to develop fall risk assessments unique to individual facilities may be counterproductive because scores will not be comparable across facilities.

This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Background/Objective: Recurring annual costs of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on health care systems, but information on costs of SCI care beyond the acute and initial postacute phase is sparse. The objective of this study was to establish a frame of reference and estimate of the annual direct medical costs associated with health care for a sample of patients with chronic SCI (ie, .2 years after injury).Methods: Patients were recruited from 3 Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross-referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific health care costs in VHA. Descriptive statistical analysis of annual DSS-NDE cost of patients with SCI (N ¼ 675) for fiscal year (FY) 2005 by level and completeness of injury was conducted.Results: Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 patients with SCI exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. Two hundred thirty-three of the 675 patients with SCI who were hospitalized over the study period accounted for a total of 378 hospital discharges, costing in excess of $7.19 million. This approximated a cost of outpatient care received of $7.28 million for our entire sample. Conclusions:The comprehensive nature of health care delivery and related cost capture for people with chronic SCI in the VHA provided us the opportunity to accurately determine health care costs for this population. Future SCI postacute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization.

Objective. To develop a valid quality measure that captures clinical inertia, the failure to initiate or intensify therapy in response to medical need, in diabetes care and to link this process measure with outcomes of glycemic control. Data Sources. Existing databases from 13 Department of Veterans Affairs hospitals between 1997 and 1999. Study Design. Laboratory results, medications, and diagnoses were collected on 23,291 patients with diabetes. We modeled the decision to increase antiglycemic medications at individual visits. We then aggregated all visits for individual patients and calculated a treatment intensity score by comparing the observed number of increases to that expected based on our model. The association between treatment intensity and two measures of glycemic control, change in HbA1c during the observation period, and whether the outcome glycosylated hemoglobin (HbA1c) was greater than 8 percent, was then examined. Principal Findings. Increases in antiglycemic medications occured at only 9.8 percent of visits despite 39 percent of patients having an initial HbA1c level greater than 8 percent. A clinically credible model predicting increase in therapy was developed with the principal predictor being a recent HbA1c greater than 8 percent. There were considerable differences in the intensity of therapy received by patients. Those patients receiving more intensive therapy had greater improvements in control ( po.001).Conclusions. Clinical inertia can be measured in diabetes care and this process measure is linked to patient outcomes of glycemic control. This measure may be useful in efforts to improve clinicians management of patients with diabetes.Key Words. Diabetes mellitus, outcomes assessment, quality of health careCentral to improving clinical practice is reliable and valid measures of the quality of care. While process and outcome measures each play an important role in quality measurement, it has long been recognized that the development of process measures that are linked to outcomes is an important r Health Research and Educational Trust

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.Key words: work-related musculoskeletal injuries, patient handling, no lift policy, ergonomics, lifting techniques, nurse safety Strategies to prevent or minimize work-related musculoskeletal injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The most common patient handling approaches in the United States include manual patient lifting, classes in body mechanics, training in safe lifting techniques, and back belts. Surprisingly there is strong evidence that each of these commonly used approaches is not effective in reducing caregiver injuries. A major paradigm shift is needed away from these ineffective approaches towards the following evidence-based practices: (a) patient handling equipment/devices, (b) patient care ergonomic assessment protocols, (c) no lift policies, (d) training on proper use of patient handling equipment/devices, and (e) patient lift teams. Promising new interventions, which are still being tested, include use of unit-based peer leaders and clinical tools, such as algorithms and patient assessment protocols. Given the complexity of this high-risk, high volume, highcost problem, multifaceted programs are more likely to be effective than any single intervention. This new call for action includes systematic change in health care facilities across the continuum of care as well as a new curriculum for schools of nursing. Statement of the ProblemNursing personnel are consistently listed as one of the top ten occupations for work-related musculoskeletal disorders, with incidence rates of 8.8 per 100 in hospital settings and 13.5 per 100 in nursing home settings (Bureau of Labor Statistics, 2002). These are considered to be low estimates, since underreporting of injuries in nursing is common (U.S. Department of Health & Human Services, 1999). Aggregated data on prevalence of back injury, compiled from over 80 studies, revealed an international worldwide point prevalence of approximately 17%, an annual prevalence of 40-50% and a lifetime prevalence of 35-80% (Hignett, 1996). While there has been a steady decline in the rates of most occupational injuries starting in 1992, work-related musculos...

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Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.Key words: work-related musculoskeletal injuries, patient handling, no lift policy, ergonomics, lifting techniques, nurse safety Strategies to prevent or minimize work-related musculoskeletal injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The most common patient handling approaches in the United States include manual patient lifting, classes in body mechanics, training in safe lifting techniques, and back belts. Surprisingly there is strong evidence that each of these commonly used approaches is not effective in reducing caregiver injuries. A major paradigm shift is needed away from these ineffective approaches towards the following evidence-based practices: (a) patient handling equipment/devices, (b) patient care ergonomic assessment protocols, (c) no lift policies, (d) training on proper use of patient handling equipment/devices, and (e) patient lift teams. Promising new interventions, which are still being tested, include use of unit-based peer leaders and clinical tools, such as algorithms and patient assessment protocols. Given the complexity of this high-risk, high volume, highcost problem, multifaceted programs are more likely to be effective than any single intervention. This new call for action includes systematic change in health care facilities across the continuum of care as well as a new curriculum for schools of nursing. Statement of the ProblemNursing personnel are consistently listed as one of the top ten occupations for work-related musculoskeletal disorders, with incidence rates of 8.8 per 100 in hospital settings and 13.5 per 100 in nursing home settings (Bureau of Labor Statistics, 2002). These are considered to be low estimates, since underreporting of injuries in nursing is common (U.S. Department of Health & Human Services, 1999). Aggregated data on prevalence of back injury, compiled from over 80 studies, revealed an international worldwide point prevalence of approximately 17%, an annual prevalence of 40-50% and a lifetime prevalence of 35-80% (Hignett, 1996). While there has been a steady decline in the rates of most occupational injuries starting in 1992, work-related musculos...