将预防跌倒策略纳入急救服务，减少老年人跌倒并降低相关医疗成本

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-22 DOI:10.2147/cia.s453961

Kathlene Camp, Sara Murphy, Brandon Pate

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引用次数: 0

摘要

目的：本研究旨在详细介绍通过紧急医疗服务（EMS）实施跌倒预防措施的情况及相关结果：方法：MedStar 移动医疗保健公司的护理人员利用 "制止老年人意外事故、死亡和伤害（STEADI）"跌倒预防模式，通过 9-1-1 紧急响应、高利用率群体（HUG）和 30 天避免再入院（HRA）计划进行筛查和指导干预。9-1-1 呼叫的结果衡量了接受跌倒筛查和识别风险因素的老年人数量。HUG和HRA项目通过EuroQol-5D、转诊服务利用率、跌倒、紧急医疗服务利用率和再入院数据来衡量生活质量的变化。分析结果包括因减少医疗使用而产生的相关成本：急诊护理人员为 50.5% （45,090 人）65 岁及以上的成年人提供了跌倒风险筛查，59.3% 的人有跌倒风险，48.1% 的人正在服用已知会增加跌倒风险的药物。通过 HUG 和 HRA 计划提供的服务以及其他所需的转介服务，与跌倒相关的 9-1-1 电话减少了 37.2%，与生活质量相关的整体健康状态提高了 29.5%。对 HUG 计划的分析表明，该计划可节省 100 多万美元，每名注册患者可节省 19 053 美元。HRA 项目的再住院率为 16.4%，而地区平均再住院率为 30.2%，为每位登记患者节省了 495 万美元或 15,618 美元：在急救医疗服务中实施 STEADI 模式为解决老年人跌倒预防问题提供了一种有效且节约成本的模式，为老年人提供了有意义且有影响的改善，可作为其他急救医疗服务项目的典范。研究结果表明，在急救服务过程中筛查老年人跌倒并将高风险老年人与社区护理人员提供的居家后续护理联系起来，是一种高效且有效的方式。此外，还为近期出院的弱势成年人提供了预防跌倒服务。通过这些预防跌倒的措施，大多数老年人在急救呼叫期间接受了预防性跌倒风险筛查，有多种合并症和跌倒风险的老年人的生活质量措施发生了显著变化，并在减少医疗服务方面节省了大量潜在成本。

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Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults

Purpose: The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes.
Methods: Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage.
Results: Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over &dollar1 million with a per-patient enrolled savings of &dollar19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of &dollar4.95 million or &dollar15,618 per enrolled patient.
Conclusion: Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.

Plain Language Summary: This study explored the feasibility and impact of implementing an evidence-based fall prevention model into emergency medical services for older adults. The outcomes resulted in an efficient and effective manner to screen older adults for falls during emergency response services and connect high-risk older adults with in-home follow-up care from community paramedics. In addition, fall prevention services were provided for vulnerable adults following a recent discharge from hospital care. These initiatives to address fall prevention resulted in a majority of older adults receiving preventive fall risk screening during emergency response calls, significant changes in quality of life measures for adults with multiple comorbidities and fall risk, and significant potential cost savings in reduced healthcare services.

Keywords: fall prevention, emergency providers, Mobile Integrated Healthcare, paramedics, age-friendly

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.