Formative evaluation of the telecare fall prevention project for older veterans
1 VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA
2 David Geffen School of Medicine at the University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
3 Network 22 Telecare, Veterans Affairs Veterans Integrated Service Network 22, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
4 Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
5 Borun Center for Gerontological Research, University of California at Los Angeles and Los Angeles Jewish Home, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA
BMC Health Services Research 2011, 11:119 doi:10.1186/1472-6963-11-119Published: 23 May 2011
Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project.
To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project.
The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project.
The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive.