Fall Prevention: Implementing Community-wide Prevention through

PartnershipsPreston Harness, MPH

Injury Prevention Coordinator, Division of Injury and Trauma Prevention

Content:

• Indiana injury prevention state plan• STEADI toolkit • Fall prevention efforts in Crawfordsville Fire

Department• Contact information

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Indiana Injury Prevention State Plan

1. Establish a sustainable and relevant infrastructure that provides leadership, funding, data, policy and evaluation for injury prevention

2. Collaborative injury prevention efforts in:•Traffic Safety•Poisoning •Traumatic Brain Injury

Injury Prevention State Plan:

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3. Statewide direction and focus for older adult (age 65+) falls prevention

4. Statewide direction and focus for child injuries• Safe sleep•Child passenger safety• Bullying

Injury Prevention State Plan(continued):

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Injury Prevention State Plan, cont’d

5. Statewide direction and focus for violence prevention• Indiana Violent Death Reporting System • Focus on homicides, suicides, and other

violence6. Enhance the skills, knowledge, &

resources of injury prevention workforce• Resource Guide• IPAC membership• IPAC conference

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Stopping Elderly Accidents, Deaths, and Injuries (STEADI)

Toolkit

STEADI Toolkit:

• Background:– Developed by Centers for Disease Control (CDC) for

healthcare providers who treat older adults who may be at risk of falling or have fallen

– Algorithm adapted from American and British Geriatric Societies’ Clinical Practice Guidelines

– Designed for patients 60+ who are outpatients

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STEADI Toolkit:

• Created via survey of primary care physicians regarding importance of falls with regards to patients

• Results showed: – Providers are aware of falls as a threat to patient but lack

information and resources – Retroactive, no proactive– Time was biggest barrier– Need to address multiple health problems with patient– Requested materials that were direct, easy to read,

checklists\flowcharts, and information easy to find online

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STEADI Toolkit:

• Integrating fall prevention into practice:– Screen all older patients for falls– Identify modifiable risk factors– Evaluate lower body strength and balance– Assess and manage postural hypotension– Review and manage medications– Increase Vitamin D– Address home safety and reduce home fall hazards

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STEADI Toolkit:

• Three components to STEADI:– Provider resources– Training materials– Patient education brochures

• All help physician\clinician to:– 1.) Screen patient for fall risk– 2.) Review medications and stop, switch, or reduce drugs

that increase fall risk– 3.) Recommend daily Vitamin D supplements of at least 800

IU\day with calcium

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STEADI Toolkit:

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23 years of experience in Fire & EMS AAS in Fire Science Protection Technology Nationally Certified & State Licensed

Paramedic Over 60 different Specialty Training

Certifications from Various Institutions around the country

Licensed teacher & Adjunct instructor for Vincennes University and Ivy Tech

Presenter for the University of Cincinnati

Our department provides ◦ EMS◦ Community Paramedicine◦ Fire protection◦ Code enforcement◦ Technical rescue◦ Haz-Mat response◦ Arson origin and cause◦ Education and training on local, State, & Federal levels

Plus over 3,600 calls per year and nearly 300 hrs. of training per FF/per year

38,000 residents Uninsured above the National benchmark 8.5% below the federal poverty level Access to primary care more than doubles

State and National averages

Community Paramedicine: EMS involvement in community health, providing physician-extender services to those in need of assessment, treatment, and education

Mobile Integrated Healthcare (MIH) is the provision of healthcare using patient-centered, mobile resources in the out-of-hospital environment.

Pillars of Service◦ Injury Prevention◦ Outreach◦ Educations

The core mission of the Crawfordsville Fire Department Division of EMS is to provide clinically sound and educated patient care with a servant’s heart for everyone entrusted to us. Crawfordsville EMT's will continuously strive for excellence in service and professionalism with every interaction on and off duty.

Improve patient-family experience Facilitate access to services Promote health among community members

suffering from heart failure 2020 Health Communities Plan

Provides the 5 right’s of patient care1. Right treatment2. At the right place3. Within the right time4. At the right quality5. And the right cost

Reduces readmissions and the risk of exposures and associated complications through a patient centered care in the comforts of their own homes in addition to reducing low acuity concerns

• Round with hospital staff and Marion D.O. clinical students prior to discharge

• First visit within 24-48 hrs. of discharge or referral

• Paramedics review care plan prior to first visit

• Two additional home visits the day following the initial visit for a total of three home visits.

• Instruct patient to keep food diary for 1 week upon admission and record daily weights

• Encourage use of Heart Failure Patient Self Care Workbook

• Identify if MD/PCP appointment has been made, and if not, assist patient in making appointment

• Conduct a thorough review of medications with primary care physician

• Conduct a Home Safety Assessment

• Conduct a comprehensive focused patient assessment

• Assess patient's comprehension of teaching Offer patients flu and pneumonia vaccinations

The IOM (Institute of Medicine) Defines patient centered as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions

CP’s work as physician extenders for in-home services.

• Franciscan Health-Crawfordsville• Wabash College• Montgomery County Health Department• Indiana State Department of Health• ISDH Trauma and Injury Division• CDC• ACO• American Heart Association (Volunteer Partner)

• Future Collaborators• Marion University D.O. Program

Locally we see between 450-500 patients◦ For every Fall encounter there is a 16% of a second

fall encounter◦ For every 2nd call, they will fall 3 or more times at a

rate of 51%◦ 195 patients fell once-35 fell at twice, and 18 fell

three or more times

Indiana 2005 – 2014 Fall deaths increased from 27.9 per 100K- 35.5 per 100K

-At 25% efficacy of STEADI, we can expect a drop of about 25 falls/year. -At 50% efficacy, we can expect a drop of about 46 falls/year. -At 75% efficacy, we can expect a drop of about 64 falls/year.

In terms of cost-savings:

-At 25% efficacy, savings of approximately $750k.

-50% efficacy: savings of $1.38 mil/year -75% efficacy: $2.37 mil/year

Presenter

Presentation Notes

Burden of Fall injuries among Indiana Residents Ages 65 and Older 2014

60% of all fall hospitalizations were discharges to a SNF

Fall resulting in a hip fracture: 71% were discharged to a skilled nursing facility and 20% discharged to rehabilitation

Among those with hip fracture, only 4% had a routine discharge to home and 5% were discharged with home health services

Cost from Falls Expected to reach 67 Billion

Falls are the leading cause of Injury related ED visits

Every 15 min an older adult visits the ED for a Fall

It’s preventable!

Expanding ways to reduce fall injuries

Follow up calls that include:◦ Home safety assessments◦ Med reconciliations◦ STEADI ◦ Socioeconomic assessments◦ Patient navigation

Montgomery County Community Foundation Indiana Rural Health Indiana Department of Homeland Security Franciscan Health-Crawfordsville

Lobbying

Falls program CMS Wellness visits 30 day Newborn follow-up

Indiana State Department of Health; Special emphasis report: Fall injuries among Older adults 2014

Preston Harness, MPH CPSTPHarness@isdh.IN.gov(314)-232-3121

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