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1.  Association Between Treatment or Usual Care Region and Hospitalization for Fall-Related Traumatic Brain Injury in the Connecticut Collaboration for Fall Prevention 
BACKGROUND
Most traumatic brain injuries among older persons in the U.S. are attributed to falls. Efforts to prevent falls may also plausibly reduce the incidence of TBIs and resultant costs.
OBJECTIVES
To evaluate the association between the treatment or usual care region of the Connecticut Collaboration for Fall Prevention (CCFP), a clinical intervention for prevention of falls, and the rate of hospitalization for fall-related traumatic brain injury (FR-TBI) among persons ≥ 70 years. The Medicare charges of FR-TBI hospitalizations are also described.
DESIGN
Using a quasi-experimental design, rates of hospitalization for FR-TBI were recorded over an eight year period (2000–2007) in two distinct geographic regions (treatment and usual care) chosen for their similarity in characteristics associated with occurrence of falls.
SETTING/PARTICIPANTS
Over 200,000 persons, 70 years and older, residing in two geographical regions in Connecticut.
INTERVENTION
Clinicians in the treatment region translated research protocols from Yale FICSIT, a successful fall prevention randomized clinical trial, into discipline- and site-specific fall prevention procedures for integration into their clinical practices.
MEASUREMENTS
The rate of hospitalization for fall-related traumatic brain injury among persons 70 years and older
RESULTS
Relative to the usual care region, CCFP’s treatment region exhibited lower rates of hospitalization for FR-TBI; RR= 0.84 with 95% credible interval (0.72 – 0.99).
CONCLUSION
The significantly lower rate of hospitalization for FR-TBI in CCFP’s treatment region suggests that the engagement of practicing clinicians in the implementation of evidence-based fall-prevention practices may reduce hospitalizations for FR-TBI.
doi:10.1111/jgs.12462
PMCID: PMC3801219  PMID: 24083593
Connecticut Collaboration for Fall Prevention; fall-related traumatic brain injury; hospitalization; Bayesian; spatial model
2.  Trends in Fall-Related Traumatic Brain Injury among Older Persons in Connecticut from 2000–2007 
Background
Anecdotal evidence suggests a rising trend in the occurrence of fall-related traumatic brain injuries (FR-TBI) among persons ≥ 70 years. To document this apparent trend on a more substantive basis, this report longitudinally describes overall and age-stratified rates of three outcomes attributed to FR-TBI among persons ≥ 70 years: emergency department visits (ED), hospitalizations, and terminal hospitalizations.
Methods
Eight years (2000–2007) of observational data from emergency departments and acute care hospitals serving a non-randomly selected, densely populated region in southern Connecticut, U.S.
Results
From 2000–2007 among persons 70 years and older, overall rates of FR-TBI visits to emergency departments more than doubled while corresponding rates of hospitalization and terminal hospitalization rose 58% each. The point estimate of growth in the rate of ED in the oldest stratum was nearly triple that of the younger stratum whereas point estimates of growth in rates of hospitalization and terminal hospitalization were nearly four times higher. Total Medicare costs for ED visits increased nearly four-fold while corresponding costs for hospitalizations and terminal hospitalizations rose by 64% and 76%. The most common discharge diagnoses for ED and hospitalization were unspecified head injury and intracranial hemorrhage.
Conclusions
The rapid rise in rates of FR-TBI and associated Medicare costs underscore the urgent need to prevent this burgeoning source of human suffering and health care utilization. We believe the rise in rates is at least partially due to a greater public awareness of the outcome that has been facilitated by increasing use of diagnostic imaging in the ED and hospital.
doi:10.4172/2167-7182.1000168
PMCID: PMC4280829  PMID: 25558438
Connecticut collaboration for fall prevention; Fall-related traumatic brain injury; Hospitalization; Emergency department; Anticoagulation therapy
3.  Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions 
OBJECTIVES
To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care.
DESIGN
Quasiexperimental; matched and unmatched.
SETTING
Community, home care.
PARTICIPANTS
Seven hundred seventy individuals receiving care from a large home care agency after hospitalization.
INTERVENTION
A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory.
MEASUREMENTS
Hospital readmission, length of home care episode.
RESULTS
Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43–1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses.
CONCLUSION
Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign.
doi:10.1111/j.1532-5415.2012.04060.x
PMCID: PMC4083654  PMID: 22860756
readmissions; restorative care; home care
4.  Integration of Fall Prevention into State Policy in Connecticut 
The Gerontologist  2012;53(3):508-515.
Purpose of Study: To describe the ongoing efforts of the Connecticut Collaboration for Fall Prevention (CCFP) to move evidence regarding fall prevention into clinical practice and state policy. Methods: A university-based team developed methods of networking with existing statewide organizations to influence clinical practice and state policy. Results: We describe steps taken that led to funding and legislation of fall prevention efforts in the state of Connecticut. We summarize CCFP’s direct outreach by tabulating the educational sessions delivered and the numbers and types of clinical care providers that were trained. Community organizations that had sustained clinical practices incorporating evidence-based fall prevention were subsequently funded through mini-grants to develop innovative interventional activities. These mini-grants targeted specific subpopulations of older persons at high risk for falls. Implications: Building collaborative relationships with existing stakeholders and care providers throughout the state, CCFP continues to facilitate the integration of evidence-based fall prevention into clinical practice and state-funded policy using strategies that may be useful to others.
doi:10.1093/geront/gns122
PMCID: PMC3635855  PMID: 23042690
Polypharmacy; Connecticut Collaboration for Fall Prevention; Balance training; Visiting nurse association; Fall prevention
5.  Effect of Dissemination of Evidence in Reducing Injuries from Falls 
The New England journal of medicine  2008;359(3):252-261.
Background
Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.
Methods
Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006.
Results
Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies).
Conclusions
Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.
doi:10.1056/NEJMoa0801748
PMCID: PMC3472807  PMID: 18635430
6.  Perspectives of Older Persons on Bathing and Bathing Disability: A Qualitative Study 
Background
Bathing is an important and potentially challenging self-care activity, and disability in bathing is associated with several adverse consequences. Little is known about older persons’ experiences with and perspectives on bathing.
Objectives
To understand the bathing experiences, attitudes, and preferences of older persons in order to inform the development of effective patient-centered interventions.
Design
Qualitative Study using the Grounded Theory framework.
Participants
Twenty-three community-living persons, age ≥ 78 years, identified from the Precipitating Events Project (PEP).
Approach
In-depth, semi-structured interviews were conducted in the participant’s home.
Results
Three themes emerged: 1) the importance and personal significance of bathing to older persons, 2) variability in attitudes, preferences, and sources of bathing assistance, and 3) older persons’ anticipation of and responses to bathing disability.
Discussion
The bathing experiences described by study participants underscore the personal significance of bathing and the need to account for attitudes and preferences when designing bathing interventions. Quantitative disability assessments may not capture the bathing modifications made by older persons in anticipation of disability and may result in missed opportunities for early intervention. Findings from this study can be used to inform the development of targeted, patient-centered interventions that can subsequently be tested in clinical trials.
doi:10.1111/j.1532-5415.2010.02722.x
PMCID: PMC2856710  PMID: 20158554
Baths; Disability; Qualitative; Preferences

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