scholarly journals Implementing a Clinically Based Fall Prevention Program

2017 ◽  
Vol 14 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Judy A. Stevens ◽  
Matthew Lee Smith ◽  
Erin M. Parker ◽  
Luohua Jiang ◽  
Frank D. Floyd
Keyword(s):  
Primary Care ◽  
Staff Training ◽  
Fall Prevention ◽  
Fall Risk ◽  
New York State ◽  
Primary Care Providers ◽  
York State Department ◽  
Care Providers ◽  
Risk Screening ◽  
Fall Risk Screening

Introduction. Among people aged 65 and older, falls are the leading cause of both fatal and nonfatal injuries. The burden of falls is expected to increase as the US population ages. The Centers for Disease Control and Prevention (CDC) developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to help primary care providers incorporate fall risk screening, assessment of patients’ modifiable risk factors, and implementation of evidence-based treatment strategies. Methods. In 2010, CDC funded the New York State Department of Health to implement STEADI in primary care sites in selected communities. The Medical Director of United Health Services championed integrating fall prevention into clinical practice and oversaw staff training. Components of STEADI were integrated into the health system’s electronic health record (EHR), and fall risk screening questions were added to the nursing staff’s patient intake forms. Results. In the first 12 months, 14 practices saw 10 702 patients aged 65 and older. Of these, 8457 patients (79.0%) were screened for fall risk and 1534 (18.1%) screened positive. About 52% of positive patients completed the Timed Up and Go gait and balance assessment. Screening declined to 49% in the second 12 months, with 21% of the patients screening positive. Conclusions. Fall prevention can be successfully integrated into primary care when it is supported by a clinical champion, coupled with timely staff training/retraining, incorporated into the EHR, and adapted to fit into the practice workflow.

FALL PREVENTION PRIMER FOR THE PRIMARY CARE PRACTIONER:

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Mindy Oxman Renfro, PhD, DPT, CPH, PT ◽  
Joyce Maring, EdD, DPT, PT ◽  
Donna Bainbridge, EdD, PT, AT-Ret
Keyword(s):  
Primary Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
Hospital Readmissions ◽  
Screening Tools ◽  
Evidence Based ◽  
Risk Screening ◽  
Quality Reporting ◽  
The Impact ◽  
Fall Risk Screening

<p><strong>ABSTRACT:</strong></p><p>One of three older adults age 65+ fall each year, and every 20 minutes an older adult dies due to injuries sustained during a fall.  Yet, most patients do not report falls to their physician.  Primary care practitioners (PCPs) are well positioned to screen for fall risk and add proactive referral patterns to both well-selected practitioners and evidence-based fall prevention (EBFP) programs designed to help older patients stay healthy, active, and independent.</p><p>The purposes of this review are to summarize the data related to the impact of falls; review efficient and reliable screening tools that identify individuals at high fall risk; describe appropriate referrals that facilitate a match between individual specific risk factors and interventions; and, highlight evidence-based fall prevention (EBFP) programs available to significantly decrease fall risk with outstanding return on investment.</p><p>Simple administrative changes in a PCP’s practice accompanied by appropriate referrals will result in proactive fall prevention including lower rates of falls and fall injuries and fewer hospitalizations and/or hospital readmissions. Fall risk screening can be built into practice to seamlessly add services without impacting practitioner productivity. Additionally, reporting fall risk screening and prevention activities in the Physician Quality Reporting System will positively impact practice Medicare reimbursement rates.</p>

scholarly journals Implementation of systematic fall risk screening in primary care: barriers and facilitators

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W M A Meekes ◽  
C J Leemrijse ◽  
J C Korevaar ◽  
L A M van de Goor
Keyword(s):  
Primary Care ◽  
Older People ◽  
Fall Prevention ◽  
Fall Risk ◽  
Barriers And Facilitators ◽  
Risk Screening ◽  
Systematic Screening ◽  
Underlying Causes ◽  
Fall Risk Screening ◽  
Adequate Communication

Abstract Background Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting. Methods The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved. Preliminary results Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice. Conclusions Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently. Key messages Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

A novel continuum-based framework for translating behavioral health integration to primary care settings

2020 ◽  
Vol 10 (3) ◽  
pp. 580-589 ◽  
Author(s):  
Matthew L Goldman ◽  
Ekaterina Smali ◽  
Talia Richkin ◽  
Harold A Pincus ◽  
Henry Chung
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Technical Assistance ◽  
New York State ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

Abstract Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised “Framework 2.0” that includes a new organization as well as the addition of a “Sustainability” domain.

Development of a Fall Prevention Survey to Determine Educational Needs for Primary Care Providers

2010 ◽  
Vol 31 (4) ◽  
pp. 310-327 ◽  
Author(s):  
B. Josea Kramer ◽  
David A. Ganz ◽  
Rebecca L. Vivrette ◽  
Judith O. Harker ◽  
Karen R. Josephson ◽  
...  
Keyword(s):  
Primary Care ◽  
Fall Prevention ◽  
Primary Care Providers ◽  
Educational Needs ◽  
Care Providers

scholarly journals Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol

2020 ◽  
Vol Volume 15 ◽  
pp. 1625-1636
Author(s):  
WMA Meekes ◽  
Chantal Leemrijse ◽  
JC Korevaar ◽  
JMAE Henquet ◽  
M Nieuwenhuis ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Study Protocol ◽  
Fall Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Strategy ◽  
Risk Screening ◽  
Frail Older Adults ◽  
Fall Risk Screening

scholarly journals Older adult fall prevention practices among primary care providers at accountable care organizations: A pilot study

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0205279 ◽  
Author(s):  
Jonathan Howland ◽  
Holly Hackman ◽  
Alyssa Taylor ◽  
Kathleen O’Hara ◽  
James Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Older Adult ◽  
Fall Prevention ◽  
Primary Care Providers ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Care Providers

Death and Grief as Experienced by Adults with Developmental Disabilities: Initial Explorations

2005 ◽  
Vol 50 (3) ◽  
pp. 181-196 ◽  
Author(s):  
John H. Hoover ◽  
Marc A. Markell ◽  
Paulette Wagner
Keyword(s):  
Primary Care ◽  
Developmental Disabilities ◽  
Staff Training ◽  
Cognitive Disabilities ◽  
Death And Dying ◽  
Primary Care Providers ◽  
Behavioral Changes ◽  
Residential Facilities ◽  
Care Providers ◽  
Wake Patterns

The experiences of persons with developmental disabilities (DD) in two northern-tier states were studied on an exploratory basis. Overall, the analysis reveals that caregivers in residential facilities believed that persons with DD (primarily global cognitive disabilities) benefit from the same grief processing rituals as other individuals. Some conflicting attitudes were revealed, however. Specifically, many respondents expressed a sense that caregivers (or family members) “know best” when individuals with disabilities prove “ready” to experience the activities and ritual surrounding loved ones' deaths. In addition, many respondents argued that clients with cognitive disabilities ought to be educated ahead of time as to what happens during the death and dying process. Primary care providers reported very few overt behavioral changes, though four clients in 10 were observed to cry more frequently (for more than 1 month) and about one-fifth reportedly experienced changes in sleep/wake patterns. Initial evidence emerged that staff training patterns varied by facility, not with years of service.

Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients

2021 ◽  
pp. 152715442110181
Author(s):  
Edward Joseph Timmons ◽  
Conor Norris ◽  
Grant Martsolf ◽  
Lusine Poghosyan
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
New York State ◽  
Primary Care Providers ◽  
Care Providers ◽  
York State ◽  
More Care ◽  
Total Care ◽  
The Impact

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

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