National Center for Health and the Aging

Transcription

1 National Center for Health and the Aging The National Center for Health and the Aging (NCHATA), a project of North American Management, is supported in part by a cooperative agreement grant awarded by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). The National Center for Health and the Aging provides training and technical assistance to strengthen the capacity of federally-funded health centers to increase access to health care, eliminate health disparities and enhance health care delivery for the 39 million or 13 percent of Americans aged 65 years age and older.

2 Preventing Older Adult Falls Through Clinical and Community Based Programming Robin Lee PhD, MPH Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention

3 Objectives Burden & impact of falls CDC s older adult falls prevention strategy Empowering older adults Educating caregivers Implementing community based resources Supporting clinical interventions

4 Introduction 30-35% of people 65+ fall each year 1 Those who fall are 2-3 times more likely to fall again 2 1 in 5 falls causes a serious injury 3 1. Tromp, J Clinical Epi, Tinetti, New Eng J Med, 1988; Teno, JAGS, Sterling, J Trauma-Inj Infection & Critical Care, 2001

5 Falls are the Leading Cause of Injury Related Death Among People 65+, 2010 Falls Motor Vehicle Suffocation Poisoning Fire/Burn Drowning Other Unspecified Total = 41,300 deaths NCHS, Vital Records, ,000 10,000 15,000 20,000 25,000 Number of Deaths

6 Rate per 100,000 Age-Adjusted Fall Death Rate for persons 65+ are on the Rise, Men 64% Women 84% Year NCHS, Vital Records,

7 Falls are the Leading Cause of Nonfatal Injuries Among People 65+, 2010 Falls Struck by/against Motor Vehicle-Occupant Cut/Pierce Poisoning Bite/Sting Other Unspecified Total = 3.7 million injuries NCHS, WISQARS, ,000,000 2,000,000 Number of Injuries

8 Economic Impact Cost of fall injuries among people 65+ Adjusted for inflation = $30 billion Fatal falls: $0.3 billion Nonfatal injuries: $29.9 billion Stevens JA, Inj Prev, 2006

9 Objectives CDC s older adult falls prevention strategy Empowering older adults Educating caregivers Implementing community based resources Supporting clinical interventions

10 Empowering Older Adults Education Home safety modifications Vision examinations Excersise

11 Educating Caregivers Caregivers can support older adults in accepting and adopting fall prevention activities Community health workers can improve health care access

12 Community Based Resources

13 YMCA Moving for Better Balance Based on evidence-based tai chi program YMCA now offers tai chi throughout the US

14 Supporting Clinical Interventions Clinical Assessment, Treatment, Referral & Follow Up

15 Stopping Elderly Accidents, Deaths & Injuries

16 Literature Review Providers did not identify falls & gait disorder or evaluate patients who reported falling 1 Only 37% of older adults asked about falls 2 Only 8% of primary care physicians used any clinical guideline on fall prevention 3 Many physicians were interested in learning about fall risk assessment & risk reduction 4 1. Rubenstein, J Am Geriatr Soc, Wenger, Ann Intern Med, Jones, Acc Anal & Prev, Robinson, J Am Geriatr Soc, 2001

17 Provider Interviews Recognized falls as a threat to older patients Lacked information on standardized assessment methods & prevention strategies More reactive than proactive in addressing falls Asked for direct, concise & easy to read materials Preferred checklists, one-pagers & on-line information

18 Flow Chart Algorithm Adapted from AGS/BGS Clinical Practice Guidelines, 2010

19 Stay Independent A validated self-risk assessment brochure Rubenstein, J Safety Res, 2011

20 Fact Sheets

21 Three Case Studies

22 Talking with Patients Based on Stages of Change

23 Gait & Balance Assessment Tools

24 Use to Link Clinical Practice with Community Programs Change clinical practice Community fall prevention or exercise programs

25 More Information All STEADI Tool Kit materials are available to view, download & print on the CDC STEADI website:

26 CDC Older Adult Falls Team Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention Judy Steven PhD, MPH Margaret Kaniewski MPH LCDR Erin Parker PhD Heidi Ehrenreich PhD, MPH Robin Lee PhD, MPH

27 Oregon Partnerships for Falls Prevention David Dowler Research Scientist Program Design and Evaluation Services Lisa Shields Senior Falls Prevention Program Coordinator Injury and Violence Prevention Program National Center for Health and Aging webinar February 5, 2014

28 Topics covered Burden of Senior Falls CDC Program Overview Oregon Sustainability Plan Highlight: Collaborating with Health Systems 2

29 How big is the problem? Falls are the leading cause of hospitalization in Oregon and the leading cause of both fatal and nonfatal injuries for seniors More hospitalizations due to falls than for suicide attempt, traffic injuries, and unintentional poisoning combined The rate of death due to falls has increased nearly two-fold (92.3%) since 2000 Hospital charges for fall hospitalization (age 65+) during 2012 were $198,944,000 with a median charge of $30,467 The rate of fatal falls for those 85+ is 26x greater than those age Injury in Oregon Annual Data Report 2013 Falls Among Older Adults in Oregon 2012 Oregon Injury Prevention Plan

30 Oregon injury hospitalization rates per 100,000 Source: Oregon Hospital Discharge Index

31 Top 3 mechanisms of injury among patients who entered the trauma registry, by age group N=12,006 Source: Oregon Trauma Registry Report

32 Blunt force head injuries among Oregon trauma system patients N=8,177 Source: Oregon Trauma Registry Report

33 Frequency of death among patients entering the Oregon trauma system, by mechanism of injury N=561 Source: Oregon Trauma Registry Report

34 Self-report of Falls Behavioral Risk Factor Surveillance System (BRFSS) Asks how many times fallen in last 3 months, and number of falls leading to injuries Percent of 65+ reporting 1 or more falls in the past 3 months Year % with at least one fall Approx CI (+/-) Sample size % +/-2.0% % +/-1.7% % +/-1.8% % +/-2.4%

35 Community Wide Efforts Can Reduce Falls Substantially A multifaceted community based falls reduction program involving medical groups and the community reduced fall related injuries by 10% in a target community This is the model for the CDC State Fall Prevention Program Tinetti, N Engl J Med 2008;359:

36 State Fall Prevention Program Systems Change Strategies Tai Chi: Moving for Better Balance Changes in clinical care 5-year program 3 state health departments Stepping On Fall Prevention Program Otago Exercise Program Technical Assistance and Evaluation 10

37 Participant data Site data Clinician data Population data Other data Evaluation Entry questionnaire Attendance log Program information Description of agency STEADI clinician baseline survey STEADI clinician 6-month follow-up survey Key informant interviews, focus groups Medical records review All Payer All Claims Reporting Program Behavioral Risk Factor Surveillance System Oregon Trauma Registry Oregon Fire & EMS Bridge Hospital discharge data Death certificate data Program costs Assessment of involvement with health system transformation Assessment of community action and policy implementation 11

38 Oregon Falls Prevention Plan Health system collaboration Health system transformation Clinician education and referrals (STEADI) Health plan coverage Community health workers and volunteers Public awareness Aging services and professional organizations 12

39 Public Health - Health System collaboration Falls prevention champions in health care Geriatrics, Primary Care, Quality Improvement, Physical Therapy & Rehabilitation, Inpatient falls prevention, ED/Trauma Key to sustainability: work together to tailor programs that align with each business model 13

40 Incentives and Motivators for Health Care and Falls Prevention Welcome to Medicare visit Annual Wellness Visit Physician Quality Reporting System (PQRS) Patient-centered Primary Care Homes 480 recognized Oregon clinics Coordinated Care Organizations (CCO) Serving 90% of Oregon Health Plan (Medicaid) members Comprehensive Primary Care initiative Oregon is one of 7 markets 67 clinics ABIM and ABFM maintenance of certification credits 14

41 Health system transformation TRIPLE AIM: better health, better care, lower costs through fundamental changes that will: Better coordinate care at patient and financing level Integrate public, physical, mental and dental health Leverage public health strategies - recognizes that 10% of health happens in medical system Measure performance Engage people in their own health Pay for outcomes, not activities Provide clear and transparent information 15

42 Coordinated Care Model Best practices to manage and coordinate care Transparency and clear information Shared responsibility for health Payment for outcomes and health Performance is measured 16

43 How Public Health and CCOs are collaborating in falls prevention Coordinated Care Organizations (CCOs) OHA provides Performance Metrics for falls prevention Networks of physical, mental, and dental health care providers for Oregon Health Plan (Medicaid) Required to work with Patient-Centered Primary Care Homes (PCPCH) 15 CCOs in operation, serving about 90% of Oregon Health Plan members Focus on prevention Responsive to community Technical assistance for STEADI implementation Technical assistance to meet quality and incentive measures Staff training in Tai Chi: Moving for Better Balance (TCMBB) and Stepping On Ambulatory Care/ED Utilization Preventive Services Medical Services Quality Improvement Comprehensive health assessment and intervention 17

44 Other health system partners Oregon Health & Science University Includes Oregon Geriatric Education Center, Rural Practice-Based Research Network, Area Health Education Center, Prevention Research Center, and ThinkFirst Oregon. Level 1 trauma center Portland VA Medical Center 2 hospitals and 9 outpatient clinics. Full falls clinic for patients at fall risk Providence Health & Services 5 states, includes 32 hospitals, 350 clinics, senior services, supported housing, 5-star health plan Legacy Health System 6 hospitals and 50 primary care clinics in OR and Vancouver WA. Level 1 trauma center Kaiser Permanente 5-star health plan, hospital, 27 outpatient clinics, 16 dental offices 18

45 Oregon Community Health Centers 32 community health centers; 25 are Federally-Qualified Health Centers Falls prevention collaborations: STEADI, Tai Chi: Moving for Better Balance, Stepping On, community outreach 19 La Clinica (Medford) Trained staff in Tai Chi: Moving for Better Balance STEADI patient education material distributed, translated to Spanish Richmond Clinic Family Medicine (OHSU) Future STEADI site Multnomah County Health Department Aging and Disability Services co-sponsors outreach events Lincoln County Health Center Exhibit table and falls presentation at County Fair

46 How Oregon is implementing STEADI in clinical settings Primary Care Oregon Health & Science University Depts. of Internal Medicine and Family Medicine CCOs (through Oregon Geriatric Education Center and Oregon Rural Practice-based Research Network) Portland VA Medical Center Providence Health & Services Physical Therapy Therapeutic Associates Physical Therapy Gresham and Sherwood Clinics OHA provides Print material Minor supplies Verification for ABIM and ABFM credits Interns for projects Technical assistance for EHR modification, IRB submission, data collection, evaluation, training Surveillance 20

47 STEADI in non-clinical settings Patient education material distributed in self-management classes, outreach events, fitness centers, senior centers Working with First Responders to distribute class listings and patient education material 21

48 Health systems and programs* Stepping On Staff instructors: Providence, Legacy, and the VA Contracts to help cover staff FTE and supplies Stepping On classes hosted at clinic sites Electronic class referrals Providence Health Plan to cover class as member benefit VA waived co-pay requirement Tai Chi: Moving for Better Balance Referrals from STEADI sites and Kaiser Over 300 instructors trained since 2011 Many health system staff trained Community Health Workers Promotores de Salud Parish Nurses Self-management leaders Dept. of Corrections staff Native American elders Otago Exercise Program Beyond the Clinic Physical Therapy Referrals from STEADI sites *Healthoregon.org/ fallprevention also promotes any Tai Chi or QiGong class geared to seniors, A Matter of Balance, and FallProof 22

49 Health plan coverage Medicare beneficiary fitness programs: Tai Chi Silver & Fit (American Specialty Health) Tai Chi: Moving for Better Balance (TCMBB) is approved programming Kaiser considering followup call from health coach for class enrollment OHA trained 60 Silver and Fit fitness instructors Silver Sneakers (Healthways) TCMBB is approved FLEX programming, enabling tai chi classes to take place outside of traditional fitness centers Providence Health Plan considering STEADI provider referrals to Silver Sneakers and Tai Chi classes SamFit (healthfirst) Part of InterCommunity CCO Staff training in Tai Chi: Moving for Better Balance (spring 2014) Oregon Geriatric Education Center training in STEADI; provider referrals 23

50 Community Health Workers and volunteers Falls Curriculum for Community Health Workers/Promotores (Metropolitan Family Service, spring 2014) Tai Chi: Moving for Better Balance and Stepping On training Pisando Fuerte pilot with Promotores de Salud (Spanish Stepping On) STEADI patient education material Trainings, presentations, and event outreach Community Health Workers Metropolitan Family Service NW Parish Nurse Ministries Promotores de Salud (Parish Health Promoters) El Programa Hispano (Catholic Charities) Self-management leaders Oregon Community Health Workers Association CCO staff Volunteer programs RSVP: Metropolitan Family Service Elders in Action VIEWS: Cascadia Behavioral Health 24

51 Aging services and professional organizations Oregon DHS - Aging & People with Disabilities Multnomah County Aging & Disability Services Oregon Physical Therapy Association Oregon Geriatrics Society Oregon Gerontological Association Oregon Primary Care Association Oregon Community Health Workers Association Portland Parks and Recreation Oregon Recreation & Parks Association Oregon Alzheimer s Association AARP Oregon OHA provides: Policy workgroup collaboration Instructor FTE for Portland Parks and Recreation pilot classes TCMBB instructor training STEADI material Website partner listing Presentations, trainings, exhibit tables at events Surveillance 25

52 Public Awareness Healthoregon.org/fallprevention Program info, class listings, instructor resources, data, news State Aging and Disability Resource Connection website Falls program listing searchable by county Falls Prevention Awareness Day 2013 Tai chi flash mob downtown Portland Press release Public Health Twitter and FaceBook Governor s and county proclamations Presentations and screenings at senior centers throughout September 26

53 Hospital Discharge Data shows Promising Trend Fall hospitalization rates per 100,000 in three older adult age groups in years, Source: Oregon Hospital Discharge Index

54 Tai Chi flash mob Senior center exercise demo Tai Chi with Multnomah County Commissioners 28

55 Contact Information Lisa Shields David Dowler 29

56 Q&A If you would like to ask the presenter a question please submit it through the questions box on your control panel If you are dialed in through your telephone and would like to verbally ask the presenter a question, use the raise hand icon on your control panel and your line will be unmuted.

57 Resources Fall Prevention Program in Hendersonville, NC National Council on Aging- Recommended Resources on Fall Prevention Preventing Falls at Home Lower Your Risk of Falling Preventing Falls: Conversation starters

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62 Contact Us Karen Williams Director of Health James Field Deputy Director of Health Dr. Jose Leon Clinical Quality Manager Johnette Peyton, MS, MPH, CHES Manager of Research, Policy and Health Promotion Rachel Logan, MPH Health Research Assistant Warren Brown Resource Manager Joy Oguntimein, MPH Health Research and Policy Analyst Devon LaPoint Management Analyst Please contact our team for Training and Technical Support