BackgroundIdentifying fall-related injuries and costs using healthcare claims data is cost-effective and easier to implement than using medical records or patient self-report to track falls. We developed a comprehensive four-step algorithm for identifying episodes of care for fall-related injuries and associated costs, using fee-for-service Medicare and Medicare Advantage health plan claims data for 2,011 patients from 5 medical groups between 2005 and 2009.MethodsFirst, as a preparatory step, we identified care received in acute inpatient and skilled nursing facility settings, in addition to emergency department visits. Second, based on diagnosis and procedure codes, we identified all fall-related claim records. Third, with these records, we identified six types of encounters for fall-related injuries, with different levels of injury and care. In the final step, we used these encounters to identify episodes of care for fall-related injuries.ResultsTo illustrate the algorithm, we present a representative example of a fall episode and examine descriptive statistics of injuries and costs for such episodes. Altogether, we found that the results support the use of our algorithm for identifying episodes of care for fall-related injuries. When we decomposed an episode, we found that the details present a realistic and coherent story of fall-related injuries and healthcare services. Variation of episode characteristics across medical groups supported the use of a complex algorithm approach, and descriptive statistics on the proportion, duration, and cost of episodes by healthcare services and injuries verified that our results are consistent with other studies.ConclusionsThis algorithm can be used to identify and analyze various types of fall-related outcomes including episodes of care, injuries, and associated costs. Furthermore, the algorithm can be applied and adopted in other fall-related studies with relative ease.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0066-z) contains supplementary material, which is available to authorized users.

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Background/Objectives Fall prevention programs implemented in primary care have had variable success in preventing falls and fall-related injuries. We investigated whether a program that improved the quality of care for falls also reduced the number of episodes of care for serious fall-related injuries. Design Non-randomized controlled trial. Setting Four community-based primary care practices. Participants Patients ≥ 75 years who screened positive for fall risk. Intervention A multi component quality improvement program (ACOVE prime) involving face-to-face clinician education about falls and decision support to prompt primary care providers to implement appropriate care, including referral to appropriate community resources, in response to patients screening positive for fall risk. Measurements Episodes of care for selected fall-related injuries, based on health care claims. Results Of the 1791 patients with data available for analysis, 1187 were in the intervention group and 604 patients were in the control group. Mean age was 83, and over two-thirds of the sample were women. After adjusting for potential confounders there were no statistically significant differences between intervention and control groups in episodes of care for fall-related injuries during the 12 month (incidence rate ratio, 1.27; 95% CI 0.93–1.73) or 24 month (incidence rate ratio, 1.18; 95% CI 0.93–1.49) period subsequent to initiation of the intervention. Conclusion Despite improving the care of falls, this quality improvement initiative did not result in a change in the number of episodes of care for serious fall-related injuries. Future work in community-based settings should test higher-intensity interventions to reduce fall-related injuries.

Technological advancement and globalization have led modern economic growth and social development in many parts of the world. Governments are also increasingly adopting new technology to uphold public safety and to protect its citizens. In particular, customs administrations have been adopting digital customs and risk management frameworks to promote free trade and traveling while preventing cross-border transport of dangerous goods and individuals. This study proposes an up-to-date dynamic information and communications technology (ICT) implementation stage model that accounts for new modern technology and transformative public organizations. An in-depth case study approach is employed by using the example of the customs services in South Korea. Specifically, this study describes how the Korea Customs Service developed its digital customs system in tandem with risk management guidelines and practices and presents quantitative data on customs and risk management outcomes.

The first enactment of a single national e-government act took place in Korea in 2001. Subsequently, the United States enacted its electronic government act in November 2002. Unified e-government acts in Korea and the United States have since been established and enforced for nearly two decades, and provide interesting case studies for examining the long-term influences of the e-government act on national e-government and digital government policies. The e-government act of the United States is much more comprehensive than the e-government act of Korea. The US e-government act focuses on strengthening the federal government’s ability to regulate the Office of Management and Budget (OMB)’s role in e-government implementation. The OMB has overall jurisdiction over the e-government promotion process and will continue to consult with ministries on appropriate budget support for each project. In contrast, the e-government law in Korea is based on electronic document processing as the basic viewpoint and has been downgraded to a level that supports document reduction and electronic processing of documents, rather than a comprehensive law that can support e-government projects. The comparative case study of e-government acts in Korea and the United States revealed that, from the standpoint of digital government transformation using information technology, it is most important to promote digital government policy directly from the ministry that manages the budget, or to establish a dedicated organization under the ministry to secure strong coordination while linking it with the budget.