Integrated Healthcare and Falls PreventionHAROON KASIM
MEDICAL HOSPITALIST
ACUTE ASSESSMENT UNIT - HORNSBY KURIN GAI HOSPITAL
Why FallsSignificant cause of harm to older people
The rate, intensity and cost of falls identify them as a national safety and quality issue
Estimated costs to the health system around 560 million in 2006/07 * -- likely to much higher now
Expenditure likely to triple by 2051*
Many of the risk factors for falls (eg delirium or balance problems) will have wider benefits beyond falls prevention.
* The Incidence and Cost of Falls Injury Among Older People in NSW 2006/07 . NSW Health
Integrated Care StrategyAIM : To facilitate a shared vision for aged care health service across acute and community health care settings towards enabling timely access to care and to empower other services to deliver appropriate care as close to home as possible. and prevent hospital readmissions.
RIGHT Patient RIGHT PLACE RIGHT TimeRight Patient : Identifying patients at risk through baseline data collection
Right Place and Right time: Enabling community based interventions and preventing hospital admission through ◦ Ongoing personalized risk assessment through use of biometric sensors
◦ Facilitating carer / consumer / provider engagement and dialogue through use of telehealth
Other Potential BenefitsFacilitates consumer engagement i.e patients, families and carer education
Progressive Data Collection could enable clinical decision support systems and machine learning
Role for collaboration Private Sector / Health insurer engagement on account enhanced ability to predict and manage falls risk
Enables data mining / application of big data analytics ,facilitates patient centered outcomes research and inter-professional collaborative learning -- helps partner with universities , specialist colleges
Proposed Design
Participants Residents of low level residential aged care facilities with one or more falls
Community dwelling older people aged 65 and above with one or more falls
? All participants must be mobile able to walk 20 metres without a walking aid
MethodsData Collection across community / acute settings with the patient centered focus
Ongoing monitoring of fall risk through use of biometric sensors
Carer / Consumer engagement to prevent admissions by levergaing telehealth
Written informed consent prior to inclusion
Ethical approval
Baseline Data CollectionDemographic information : Gender, Martial Status, Ethnicity ,Social Supports, living circumstances,
General Health : Pre- existing medical conditions ,medications, previous falls
Physical and Functional Assessments : PPA, SPPB , TUG, IPEQ, Hand grip dynamometer
Neuropsychological assessment : Mini-Cog, ACE-III , Trail Making Test , Digit Symbol Coding Test, Digit Span Backward Test , Attention Network Test, Single Task Measure
Ongoing MonitoringSensor Based Assessments : Balance tests ( Semi-tandem / Near Tandem/ Tandem Stance) , Sit to stand test ( strength, power, balance) , stepping reaction time , hand reaction time
Telehealth and Early InterventionTelehealth to facilitate early community based intervention through greater engagement of consumers , carers and providers
User Acceptance SurveysPatient Self Administered Questionaries' : ◦ WHODAS ( Ax general Health) ,
◦ PHQ-9 ,
◦ EQ - 5D-5L,
◦ Icon FES
Patient Centred Cloud
Integrated Care Framework - Multi sector information access enabling collaborative decision making
Acute care and Specialist Services
Outcome MeasuresSelf Controlled Case series to compare
◦ Primary end points : ED presentations before and after introduction of Integrated Care Strategy
◦ Secondary end points :◦ Patient Reported Outcomes : WHODAS ( Ax general Health) , PHQ-9 , EQ - 5D-5L, Icon FES
◦ ? Hospitalizations ,Hospital Length of Stays ,Transition to higher level of care
◦ User Acceptance
◦ Stakeholder Feasibility studies -- Stakeholder
Some Potential BarriersGovernance structures for data sharing
Issues around data ownership