BACKGROUND/RATIONALE:
Hip fractures are a high cost, high volume event for health systems; they result in significant death and disability for the individual and are preventable through proper identification of those at risk and appropriate use of hip protectors. Approximately 35-40% of community dwelling older persons fall annually. Fractures are the major category of injuries produced by falls with 87% of all fractures, in older adults, resulting from falls. Of those who fall, 20-30% suffer moderate to severe injuries. Primary care providers do not typically query elder patients about fall risk factors or fall history, unless a serious fall is reported. Consequently, the opportunity for fall prevention is often overlooked, with risks being evident only after a serious injury.

OBJECTIVE(S):
The VHA National Patient Safety Center has identified hip protectors as a priority for the VHA for hip fracture prevention in elderly veterans. The proposed initiative enhances clinical interventions to prevent functional decline among vulnerable veterans. The purpose of this six-month planning program is to develop the rools necessary to overcome barriers for hip protector use in primary care.

METHODS:
Focus groups and survey methods will be used to identify barriers and nominal group process to match interventions to local barriers. One local opinion leader from each CBOC and primary care clinic in VISN 8 will be invited to participate in a videoconference session and a strategic planning session. Target patient informants will be veterans over age 65 who are identified as high risk for falls and their significant others. Target provider participants will be primary care physicians, nurses, medical technicians, and physical therapists who have direct contact with outpatient veterans at risk for falls. Key informants will vary by local site, but are expected to include hospital and clinic administrators, purchasers, VAMC patient safety officers, and facility leaders in geriatrics and rehabilitation.

FINDINGS/RESULTS:
Planning program is in development.

IMPACT:
The anticipated impact is that the proposed planning activities will result in a strategic plan and a variety of clinical tools for overcoming local barriers. We expect a menu of clinical tools including interactive CD training for primary care providers, patients and families, educational brochures, posters, algorithms, a risk assessment template, and standing orders in CPRS for providers. These tools will be used to develop a full proposal for a clinical trial to test the effectiveness of the hip protector program using implementation strategies matched to local barriers, and using local clinical champions and social marketing techniques.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Bulat T, Quigley P. External hip protectors and risk of hip fracture. JAMA : the journal of the American Medical Association. 2003 Aug 20; 290(7):883; author reply 884-5. [view]
2. Bulat T, Powell-Cope G, Rubenstein L. Perceived barriers and facilitators to the use of external hip protectors. Gerontechnology : international journal on the fundamental aspects of technology to serve the ageing society. 2004 Jun 1; 3(1):5-15. [view]

Conference Presentations

1. Bulat T. Barriers to adoption: consumer perspective. Paper presented at: Centers for Disease Control and Prevention Injury Center Hip Protector Use Annual Conference; 2004 Jun 1; Boston, MA. [view]
2. Bulat T, Hart-Hughes S, Quigley P, Friedman Y. Evidence-based falls clinic. Paper presented at: VA VISN 8 Ambulatory Care Forum; 2003 Sep 1; Tampa, FL. [view]
3. Bulat T, Hart-Hughes S, Friedman Y. How to establish a fall prevention clinic. Paper presented at: University of South Florida Transforming Fall Management Practices Conference; 2004 Mar 1; Clearwater, FL. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems Science
DRE: Prevention
Keywords: Falls, Frail elderly, Implementation
MeSH Terms: Patient Compliance, Health Plan Implementation