Does the New Fall- and Fracture Prevention Initiative in Oslo Have Effect?

Study Overview
=================
Brief Summary
-----------------
The goal of this controlled before and after study is to evaluate a new patient pathway for patients 65 years and older who have suffered a fall injury. The main questions the study aims to answer are whether this preventive initiative with improved care coordination reduces risk of subsequent hip fractures, admittance to nursing homes or death. Researchers will compare two boroughs in Oslo who implemented the new patient pathway with the 13 other boroughs who did not reorganize their follow-up, but continued their care as usual.

Detailed Description
-----------------
The study is an evaluation of a new patient follow-up for fall prevention in Oslo with improvement of coordination of care for elderly at risk of fall injuries. The intervention were introduced to the boroughs of Nordstrand and Østensjø, which are compared to the other 13 boroughs of Oslo in this controlled before and after study. THE COHORT All persons 65 years and older in Oslo are included in Oslo Fall Cohort and we follow all cohort participants prospectively. OUTCOME VARIABLES Hip fracture Long term admittance to nursing home Death TIMELINE The investigators have defined the following dates as the start of intervention: Start of intervention in Nordstrand borough is set to January 1, 2015. Start of intervention Østensjø borough is set to September 1, 2016. In the main analysis, fallers from the two intervention boroughs, Nordstrand and Østensjø, will be compared with fallers from the control boroughs during the intervention. Any differences between the intervention and control boroughs before the intervention started will be taken into account. Data on all participants are available from 2010, and the participants will be followed from January 2012 until December 2019. For each analysis, persons with a hip fracture or living in a nursing home at baseline will be excluded. The analysis in the evaluation is based on registry data and no analysis relating the intervention to the outcomes has been done before registration in clinicaltrials.gov.

Official Title
-----------------
Does the Improved Coordination of Care for Fall- and Fracture Prevention in Oslo Have Effect on the Rate of Hip Fractures, Need of Nursing Homes or Death?

Conditions
-----------------
Fall Injury, Hip Fractures

Intervention / Treatment
-----------------
* Other: Implement coordination of care with multifactorial falls- and fracture risk assessment and tailored intervention


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 65 years or older Living on Oslo, Norway in the period January 1. 2012 - December 31. 2019 Exclusion Criteria: Hip fracture before baseline Living in nursing home at baseline

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| FALLERS IN THE INTERVENTION BOROUGHS<br>Fallers 65+ years from the borough of Nordstrand from January 1. 2015 Fallers 65+ years from the borough of Østensjø from September 1. 2016 Fall injury will be included as a time-varying exposure variable. The individuals are all registered as non-fallers until they are registered with a fall injury in the NPR database, when they shift status to fallers. | Other: Implement coordination of care with multifactorial falls- and fracture risk assessment and tailored intervention<br> <br> * Other names: Technology enablers in the electronic patients records;|
| FALLERS IN THE CONTROL BOROUGHS<br>Fallers 65+ years from all the 13 other boroughs of Oslo. Fall injury will be included as a time-varying exposure variable. The individuals are all registered as non-fallers until they are registered with a fall injury in the NPR database, when they shift status to fallers. | |
| NON-FALLERS<br>All non-fallers 65+ years from all Oslo boroughs. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hip fracture | A new hip fracture registered in the Norwegian Patient registry | 2012-2019 | 
| Admission to nursing home | Long-term admission to nursing home | 2012-2019 | 
| Death | Total mortality | 2012-2019 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subsequent fall injuries | Subsequent falls that result in injuries registered in the Norwegian Patient Registry | 2012-1019 |