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A Practice-Based Intervention to Improve Primary Care for Falls, Urinary Incontinence, and Dementia |
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| Authors: | Neil S Wenger MD MPH Carol P Roth RN MPH Paul G Shekelle MD PhD Roy T Young MD David H Solomon MD Caren J Kamberg MSPH John T Chang MD MPH Rachel Louie MS Takahiro Higashi MD PhD Catherine H MacLean MD PhD John Adams PhD Lillian C Min MD Kurt Ransohoff MD Marc Hoffing MD David B Reuben MD |
| Institution: | From RAND, Santa Monica, California;;Department of Medicine, University of California at Los Angeles, Los Angeles, California;;Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California;;RAND, Washington, District of Columbia;;Zynx Health, Los Angeles, California;;National Cancer Center, Tokyo, Japan;;Programs for Clinical Excellence, WellPoint, Inc., Woodland Hills, California;;Sansum-Santa Barbara Medical Foundation Clinic, Santa Barbara, California;and;Desert Medical Group, Palm Springs, California. |
| Abstract: | OBJECTIVES: To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment. DESIGN: Controlled trial. SETTING: Two community medical groups. PARTICIPANTS: Community-dwelling patients (357 at intervention sites and 287 at control sites) aged 75 and older identified as having difficulty with falls, incontinence, or cognitive impairment. INTERVENTION: Intervention and control practices received condition case-finding, but only intervention practices received a multicomponent practice-change intervention. MEASUREMENTS: Percentage of quality indicators satisfied measured using a 13-month medical record abstraction. RESULTS: Before the intervention, the quality of care was the same in intervention and control groups. Screening tripled the number of patients identified as needing care for falls, incontinence, or cognitive impairment. During the intervention, overall care for the three conditions was better in the intervention than the control group (41%, 95% confidence interval (CI)=35–46% vs 25%, 95% CI=20–30%, P <.001). Intervention group patients received better care for falls (44% vs 23%, P <.001) and incontinence (37% vs 22%, P <.001) but not for cognitive impairment (44% vs 41%, P =.67) than control group patients. The intervention was more effective for conditions identified by screening than for conditions identified through usual care. CONCLUSION: A practice-based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence, although even with the intervention, less than half of the recommended care for these conditions was provided. More-intensive interventions, such as embedding intervention components into an electronic medical record, will be needed to adequately improve care for falls and incontinence. |
| Keywords: | practice-based intervention geriatric quality of care clinical care improvement |