Integration of Fall Prevention into State Policy in Connecticut

Fall-related injuries are one of the most common, disruptive, and costly health conditions experienced by older adults in the United States (Centers for Disease Control and Prevention). Although randomized controlled trials support the efficacy of multicomponent fall-prevention strategies in reducing these risks (American Geriatrics Society, 2010; Tinetti et al., 1994), effective strategies to prevent falls are underutilized. As has been described in detail elsewhere, the Connecticut Collaboration for Fall Prevention (CCFP) is an ongoing 12-year effort designed to move evidence regarding prevention of falls among older persons into use by the variety of clinicians and practice settings where older adults receive health care (Baker et al., 2005; Chou, Tinetti, King, Irwin, & Fortinsky, 2006; Fortinsky et al., 2004). To accomplish this, research protocols were converted into clinical assessment guidelines and patient education materials by workgroups of clinicians from a variety of settings including outpatient rehabilitation, home care, emergency room, and the offices of primary care physicians. Using these materials, a multidisciplinary cadre of CCFP investigators actively recruited clinical sites throughout an intervention region and provided them with materials and in-service educational sessions. A database was developed to register individual participants and to send a monthly newsletter providing updates regarding CCFP and current research in fall prevention. The evaluation plan assessed the effectiveness of the intervention in reducing the number of older adults admitted for emergency or hospital care for fall-related injury in the intervention region relative to a usual-care area selected to be similar at an aggregate level on key fall-related factors (Murphy, Tinetti, & Allore, 2008; Murphy, Allore, Leo-Summers, & Carlin, 2011; Tinetti et al., 2008). Over a two-year evaluation period, the intervention area experienced a 9% decline in the rate of serious fall-related injury admissions relative to that of the usual-care area. Over the same period, a decline of 11% in the adjusted rate of overall fall-related use of medical services in the intervention area with respect to the usual-care area was also documented. The evaluations of serious and overall fall-related injury each employed Bayesian Poisson models that adjusted for spatial correlation, age, sex, time period within the study, and the following zip-code specific covariates: baseline rate of fall-related injury, proportion of 65+ households with income ≤ $15,000, proportion of 65+ households with income ≥ $75,000, proportion of 65+ persons living in institutions, proportion of 65+ noninstitutionalized persons with physical disability, and the proportion of 65+ persons with self-reported race that was non-White. The intervention and usual-care areas are presented in Figure 1. For notational purposes, in this article we will refer to the initial research study as CCFP1, which took place over the years 2000 through 2006. Figure 1. Usual care and intervention arms of the Connecticut Collaboration for Fall Prevention 1 (2000–2006).