Fall prevention and urinary incontinence care improved by intervention

A practice redesign project was successful in getting primary care practices to provide recommended geriatric care, a new study found.

The project, in which ACP was a partner, compared five practices that received Assessing Care of Vulnerable Elders Practice Redesign for Improved Medical Care for Elders (ACOVEprime) intervention with five control practices. At both intervention and control clinics, all patients 75 and older were screened for fall risk and urinary incontinence. The intervention practices received assistance through efficient collection of data related to the conditions, medical record prompts, patient education materials and physician decision support.

Overall, 47% of the 6,051 patients screened positive for falls or urinary incontinence. In the intervention practices, 60% of the patients received recommended care for falls, compared to 37.6% in the control practices (P<0.001). Clinicians in these practices were more likely to perform a fall history, orthostatic blood pressure measurement, and gait and balance examination. The intervention practices also complied more frequently with recommendations for urinary incontinence treatment (47.2% vs. 27.8% of patients, P<0.001). They were more likely to ask about incontinence history and start with behavioral treatments.

The use of recommended care in the control practices was similar to that seen in other studies, while the intervention brought practices up to quality levels usually seen for nongeriatric medical conditions, the study authors noted. They found that the intervention appeared to be effective at all five sites, although the one site which used a fully integrated electronic health record showed higher quality scores than the others.

The results prove that such an intervention can be implemented in medium and small practices without a research infrastructure, and that quality improvement supported by professional societies has broad potential to reach such practices, the study authors concluded. The study was published in the Oct. 25 Archives of Internal Medicine.

The project was also notable for its efficiency and acceptability to the practices, according to an accompanying commentary. All of the participants were volunteers interested in improving geriatric care and they received the incentive of potential Maintenance of Certification credit, the study authors noted. Components of the intervention are available on the ACP website.