The Value of Assessing Falls in an Elderly Population

Rubenstein, Laurence Z.; Robbins, Alan S.; Josephson, Karen R.; Schulman, Barbara; Osterweil, Dan

doi:10.7326/0003-4819-113-4-308

Cited by 333 publications

(157 citation statements)

References 20 publications

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“…[24][25][26][27][28][29][30][31][32] These studies indicate that prospective payment reduced hospital costs by reducing the average LOS. [24][25][26]29,30 A large study 27,33 of Medicare beneficiaries (n=16,758) in which half were hospitalized prior to prospective payment and half after found that the overall quality of care, measured by comparing the care received to particular standards (ie, not by measures of outcome) and the process of care improved following the introduction of prospective payment. This study and others also found no evidence that mortality increased after prospective payment was introduced.…”

Section: Discussionmentioning

confidence: 99%

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

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Objective-To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design-Data from the nationally representative Medicare Current Beneficiary Survey (MCBS)were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings-Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants-Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions-Not applicable.Main Outcome Measures-Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results-Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This article uses a nationally representative database to analyze the use of 2 PAC servicesphysical (PT) and occupational therapy (OT)-by Medicare beneficiaries with five common diagnoses across various settings of care before and after the 1997 BBA. Looking simultaneously at service use across different rehabilitation settings is important because changes in 1 sector could alter care patterns in another setting. Additionally, exploring changes in service use is complicated by differing timeframes for implementing BBAmandated prospective payment across PAC settings (fig 1). For instance, the BBA created an interim payment system for home health agencies, which was phased in over 12 months beginning October 1, 1997, and controlled both average spending per visit and per Medicare beneficiary; full home health agency prospective payment was implemented in October 2000. A prospective payment system (PPS) was implemented for SNFs in July 1998, and in January 2002 for IRFs. For outpatient therapy, the BBA imposed 2 annual $1500 caps-one for PT...

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Section: Discussionmentioning

confidence: 99%

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

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“…In one randomized controlled trial, a focused history and physical assessment by nurse practitioners following a fall resulted in identification of modifiable medical conditions and decreased hospitalization rates over 2 years of follow-up. 406 There is an overwhelming consensus that fall prevention strategies work.Those patients who have already had a fragility fracture deserve proper evaluation, education, and treatment.…”

Section: Discussionmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

131

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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“…Residential care dwellers (58,59,82,98,99,(106)(107)(108)(109)110) In long-term care and residential care settings assessment for risk and appropriate multifactorial interventions for all residents (including those with dementia and cognitive impairment) there is some evidence to support: Exercise (83,87,89-98, 102,107 ) Specific exercise programmes work best within a multifactorial fall-prevention programme but there is evidence that they work alone as well.…”

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confidence: 99%

Analysis of Fall Injuries by Body Mass Index

Ren¹,

Waclawczyk²,

Hartfield³

et al. 2014

Southern Medical Journal

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This report is HEN's response to a question from a decision-maker. It provides a synthesis of the best available evidence, including a summary of the main findings and policy options related to the issue. Fall prevention programmes can be effective in reducing the number of people who fall and the rate of falls. Targeted strategies aimed at behavioural change and risk modification for those living in the community appear to be most promising. Multifactorial intervention programmes that include risk factor assessment and screening have been shown to be effective. However, no screening tools have been rigorously validated across countries and further work is needed in this area.HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.

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The Value of Assessing Falls in an Elderly Population

Abstract: Our study suggests that falls are a marker of underlying disorders easily identifiable by a careful postfall assessment, which in turn can reduce disability and costs.

Cited by 333 publications

References 20 publications

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Analysis of Fall Injuries by Body Mass Index

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