Prehospital and Posthospital Fall Injuries in Older US Adults

Hoffman, Geoffrey J.; Tinetti, Mary E.; Ha, Jae Jung; Alexander, Neil B.; Min, Lillian

doi:10.1001/jamanetworkopen.2020.13243

Cited by 10 publications

(10 citation statements)

References 51 publications

(129 reference statements)

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“…1 Despite decades of reports, publications, and public health initiatives, rates of falling have increased by approximately 3% per year for the past 10 years. 2 Incidence of falls are known to be higher for patients immediately before 3 and immediately after a hospital admission. [3][4][5][6] Furthermore, individualized fall prevention programs in hospitals have been largely ineffective 7 and fall-related injuries account for a significant number of hospital readmissions.…”

Section: Introductionmentioning

confidence: 99%

“…2 Incidence of falls are known to be higher for patients immediately before 3 and immediately after a hospital admission. 3-6 Furthermore, individualized fall prevention programs in hospitals have been largely ineffective 7 and fall-related injuries account for a significant number of hospital readmissions. 8,9…”

Section: Introductionmentioning

confidence: 99%

“…2 Incidence of falls are known to be higher for patients immediately before 3 and immediately after a hospital admission. [3][4][5][6] Furthermore, individualized fall prevention programs in hospitals have been largely ineffective 7 and fall-related injuries account for a significant number of hospital readmissions. 8,9 Hospital fall prevention is an interdisciplinary effort, and physical therapy is often recommended for patients deemed by medical providers as being at higher risk for falling.…”

Section: Introductionmentioning

confidence: 99%

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Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

et al. 2023

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Background: Falls in and following hospitalization are common and problematic. Little is understood about the factors that impede or promote effective implementation of fall prevention practices. Purpose and Relevance: Physical therapists are commonly consulted for acute care patients at risk for falling. The purpose of this study is to understand therapist perceptions of their effectiveness in fall prevention and to explore the impact of contextual factors on practice patterns to prevent falls surrounding hospitalization. Methods: Survey questions were tailored to the constructs of hospital culture, structural characteristics, networks and communications, and implementation climate, in addition to inquiries regarding practice patterns and attitudes/beliefs. Results: Overall, 179 surveys were analyzed. Most therapists (n 5 135, 75.4%) affirmed their hospital prioritizes best practices for fall prevention, although fewer agreed that therapists other than themselves provide optimal fall prevention intervention (n 5 105, 58.7%). Less practice experience was associated with greater odds of affirming that contextual factors influence fall prevention practice (odds ratio 3.90, p , .001). Respondents who agreed that their hospital system prioritizes best practices for fall prevention had 14 times the odds of believing that their system prioritizes making improvements (p 5 .002). Conclusions/Implications: As experience influences fall prevention practice, quality assurance and improvement initiatives should be used to ensure minimum specifications of practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

et al. 2023

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“…Fall injuries can threaten older Americans' well-being and independence, with risks substantially increasing after a hospitalization when patients are often most vulnerable. [1][2][3][4] Fall injuries are common, costly, and to an extent preventable, but continue to increase over time, with critical implications for older adults' health, functioning, and independence. 5 By virtue of financial incentives tied to Medicare reimbursement, proponents of the Center of Medicare and Medicaid's (CMS) Hospital Readmissions Reduction Program (HRRP) believed it would improve transitional care, benefitting patient education, medication management, and community-based follow-up care.…”

Section: Introductionmentioning

confidence: 99%

Medicare's Hospital Readmission Reduction Program reduced fall‐related health care use: An unexpected benefit?

Hoffman,

Alexander,

et al. 2023

Health Services Research

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ObjectiveTo assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall‐related injuries (FRIs).Data Sources and Study SettingSecondary data from Medicare were used.Study DesignUsing an event study design, among older (≥65) Medicare fee‐for‐service beneficiaries, we assessed changes in 30‐ and 90‐day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus “non‐targeted” (gastrointestinal) conditions. We tested for modification by hospitals with “high‐risk” before HRRP and accounted for potential upcoding. We also explored changes in 30‐day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities).Data CollectionNot applicable.Principal FindingsWe identified 1.5 million (522,596 pre‐HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%–20% reductions in 30‐ and 90‐day FRI readmissions for patients with CHF (−0.42 percentage points [ppt], p = 0.02; −1.53 ppt, p < 0.001) and AMI (−0.35, p = 0.047; −0.97, p = 0.001). Two years after implementation, HRRP was associated with reductions in 90‐day FRI readmission for AMI (−1.27 ppt, p = 0.01) and CHF (−0.98 ppt, p = 0.02) patients. Results were similar for hospitals at higher versus lower baseline risk of FRI readmission. After HRRP's announcement, decreases were observed in home health (AMI: −2.43 ppt, p < 0.001; CHF: −8.83 ppt, p < 0.001; pneumonia: −1.97 ppt, p < 0.001) and skilled nursing facility referrals (AMI: −5.95 ppt, p < 0.001; CHF: −3.19 ppt, p < 0.001; pneumonia: −10.27 ppt, p < 0.001).ConclusionsHRRP was associated with reductions in FRIs, primarily for HF and pneumonia patients. These decreases may reflect improvements in transitional care including changes in post‐acute referral patterns that benefit patients at risk for falls.

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“…Proposed solutions to this misallocation of resources often involve prevention efforts intended to reduce the number of common, low‐acuity incidents resulting in 9‐1‐1 calls, including falls (Cone et al, 2012; Faul et al., 2016; Ganz & Latham, 2020; Gillespie et al, 2009; Quatman et al., 2018; Snooks et al., 2017). More recently, new payment models have been proposed in the United States that could allow agencies to receive some reimbursement for providing on‐scene treatment for lower acuity patients or transportation to non‐hospital care (Center for Medicare & Medicaid Services [CMS], 2019b; Hoffman et al., 2020; Munjal et al., 2019; ‘New Pa. law provides reimbursement for non‐transport calls’, 2018).…”

Section: Introductionmentioning

confidence: 99%

Trends in fall‐related encounters and predictors of non‐transport at a US Emergency Medical Services Agency

Jeruzal

Boland

Jin

et al. 2021

Health Social Care Comm

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Non-transport to a hospital after emergency medical services (EMS) encounters for falls is common. However, incident factors associated with non-transport have not been well studied, especially beyond older adults. The objectives of this study are to (1) describe trends in fall-related EMS utilisation among adult patients from 2010 to 2018; (2) describe incident characteristics by age; and (3) identify incident factors associated with non-transport following a fall. This retrospective observational study includes prehospital clinical records data on falls from a large ambulance service in Minnesota, USA. Multivariable logistic regression was used to assess the independent association between non-transport and the following factors: sex, age, race, previous fall-related EMS encounter, incident location and primary impression. Of 62,835 fall-related encounters studied, 14.7% (9,245) did not result in transport by EMS. Fall calls were less common among younger people and the location and medical conditions primarily treated by an EMS provider during a 9-1-1 call differed greatly from those occurring among patients 65 and older. Factors most strongly associated with an increased risk of non-transport in the multivariable model were a primary impression of 'No apparent illness/injury' (OR = 34.5, 95% CI = 30.7-38.7), falling in a public location (OR = 2.09, CI = 1.96-2.22) and having had a fall-related EMS encounter during the prior year (OR = 1.15, CI = 1.1-1.2). Falls that occur in public locations, in patients with a previous fall, or result in no clinical detection of apparent illness or injury have a significantly increased odds of non-transport. Non-transport fall incidents in the United States require significant agency resources. Knowledge about the incident factors associated with non-transport calls is informative for development of alternative models for prehospital care delivery and initiatives to better serve patients.

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Prehospital and Posthospital Fall Injuries in Older US Adults

Cited by 10 publications

References 51 publications

Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

Medicare's Hospital Readmission Reduction Program reduced fall‐related health care use: An unexpected benefit?

Trends in fall‐related encounters and predictors of non‐transport at a US Emergency Medical Services Agency

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