protocolSection identificationModule nctId: NCT06304428, orgStudyIdInfo id: Pro00114580, briefTitle: Prevention of Injury in Skilled Nursing Facilities Through Optimizing Medications, acronym: PRISM, statusModule overallStatus: NOT_YET_RECRUITING, startDateStruct date: 2024-10-01, primaryCompletionDateStruct date: 2028-07-01, completionDateStruct date: 2028-07-01, studyFirstPostDateStruct date: 2024-03-12, lastUpdatePostDateStruct date: 2024-03-12, sponsorCollaboratorsModule leadSponsor name: Duke University, class: OTHER, collaborators name: Patient-Centered Outcomes Research Institute, collaborators name: Hebrew SeniorLife, collaborators name: Brown University, collaborators name: The American Health Care Association, collaborators name: University of North Carolina, Chapel Hill, descriptionModule briefSummary: The goal of this clinical trial is to compare three care models for optimizing medications and preventing falls with broken bones in patients receiving rehabilitation after a hospitalization for a broken bone.The primary outcome is injurious falls, with secondary outcomes measuring how the process of care is changed and capturing patient-reported outcomes valued by stakeholders.The main questions this study aims to answer are:* Which of the three models is more effective in preventing falls with fractures?* What are the differences in patient-centered outcomes amongst the three models? These include pain, depression, anxiety, sleep, medication side effect burden, and fear of falling.* What are the differences in osteoporosis treatment and medication burden?The three care models are: a Deprescribing Care Model designed to reduce or stop fall-related medications, a Bone Heath Service Model designed to provide osteoporosis evaluation and management, and an Injury Prevention Service Model offering both services.42 SNFs will participate in this study. The three models will be incorporated into the routine care of patients at these facilities who are receiving rehabilitation after a hospitalization for a fracture. All care models will be delivered remotely to patients in the SNF and after they transition home by a post-fracture nurse consultant supported by an interprofessional team.This study has three aims. See Detailed Description for more details. This ClinicalTrials.gov record represents the Comparative Effectiveness Aim of the protocol., conditionsModule conditions: Accidental Falls/Prevention and Control, conditions: Osteoporosis, designModule studyType: INTERVENTIONAL, phases: NA, designInfo allocation: RANDOMIZED, interventionModel: CROSSOVER, primaryPurpose: PREVENTION, maskingInfo masking: NONE, enrollmentInfo count: 3780, type: ESTIMATED, armsInterventionsModule interventions name: Deprescribing Care Model, interventions name: Bone Health Service Model, interventions name: Injury Prevention Service Model, outcomesModule primaryOutcomes measure: Injurious falls, secondaryOutcomes measure: Number of patients who initiate treatment for osteoporosis, secondaryOutcomes measure: Medication Possession Ratio during follow-up, as measured by EHR and Medicare claims, secondaryOutcomes measure: Number of patients who had deprescribing ordered, secondaryOutcomes measure: Modified Drug Burden Index during follow-up, as measured by EHR and Medicare claims, secondaryOutcomes measure: Patient medication side effect burden, measured via Living with Medicines Questionnaire (LMQ3)., secondaryOutcomes measure: Patient falls self-efficacy (i.e. fear of falling), measured via Falls Efficacy Scale, secondaryOutcomes measure: Patient pain, measured via Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form, secondaryOutcomes measure: Patient depression, measured via Patient Health Questionnaire survey (PHQ-8), secondaryOutcomes measure: Patient anxiety, measured via PROMIS anxiety short form survey, secondaryOutcomes measure: Patient sleep, measured via PROMIS sleep disturbance short form, eligibilityModule sex: ALL, minimumAge: 65 Years, stdAges: OLDER_ADULT, contactsLocationsModule, hasResults: False