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Formative evaluation of the telecare fall prevention project for older veterans

BACKGROUND: Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for fa...

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Autores principales: Miake-Lye, Isomi M, Amulis, Angel, Saliba, Debra, Shekelle, Paul G, Volkman, Linda K, Ganz, David A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127979/
https://www.ncbi.nlm.nih.gov/pubmed/21605438
http://dx.doi.org/10.1186/1472-6963-11-119
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author Miake-Lye, Isomi M
Amulis, Angel
Saliba, Debra
Shekelle, Paul G
Volkman, Linda K
Ganz, David A
author_facet Miake-Lye, Isomi M
Amulis, Angel
Saliba, Debra
Shekelle, Paul G
Volkman, Linda K
Ganz, David A
author_sort Miake-Lye, Isomi M
collection PubMed
description BACKGROUND: Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project. METHODS: To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project. RESULTS: The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project. CONCLUSIONS: The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive.
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spelling pubmed-31279792011-07-01 Formative evaluation of the telecare fall prevention project for older veterans Miake-Lye, Isomi M Amulis, Angel Saliba, Debra Shekelle, Paul G Volkman, Linda K Ganz, David A BMC Health Serv Res Correspondence BACKGROUND: Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project. METHODS: To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project. RESULTS: The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project. CONCLUSIONS: The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive. BioMed Central 2011-05-23 /pmc/articles/PMC3127979/ /pubmed/21605438 http://dx.doi.org/10.1186/1472-6963-11-119 Text en Copyright ©2011 Miake-Lye et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Correspondence
Miake-Lye, Isomi M
Amulis, Angel
Saliba, Debra
Shekelle, Paul G
Volkman, Linda K
Ganz, David A
Formative evaluation of the telecare fall prevention project for older veterans
title Formative evaluation of the telecare fall prevention project for older veterans
title_full Formative evaluation of the telecare fall prevention project for older veterans
title_fullStr Formative evaluation of the telecare fall prevention project for older veterans
title_full_unstemmed Formative evaluation of the telecare fall prevention project for older veterans
title_short Formative evaluation of the telecare fall prevention project for older veterans
title_sort formative evaluation of the telecare fall prevention project for older veterans
topic Correspondence
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127979/
https://www.ncbi.nlm.nih.gov/pubmed/21605438
http://dx.doi.org/10.1186/1472-6963-11-119
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