DESCRIPTION (provided by applicant): Falls are among the most common and most devastating conditions of aging. Each year approximately 1/3 of older adults fall and approximately 10% of these falls result in major injuries including hip fractures. Although the implementation of falls prevention programs can reduce fall rates, such programs are not widely available and the current quality of care of falls is poor. Thus, falls are among the most important conditions affected by deficits in quality of care and should be a major target for quality improvement efforts. The proposed research builds upon a large controlled trial, ACOVEprime, conducted at 5 community-based practices. ACOVEprime used the ACOVE-2 Intervention to improve the quality of care that primary care physicians provide for falls and urinary incontinence. The ACOVE-2 practice redesign intervention includes 5 components: 1) case finding; 2) efficient collection of condition-specific clinical data; 3) medical record prompts; 4) patient and family education materials, including linkages to community resources; and 5) physician decision support and physician and staff education. In ACOVEprime, the effect of the ACOVE-2 Intervention on the overall quality of falls care was dramatic. In the intervention group, 60% of quality indicators were passed compared to 38% in the control group, a 58% effect size. However, ACOVEprime did not measure outcome data. We propose to use data already collected in the ACOVEprime study and link these data to Medicare claims data, which will enable us to examine the effects of the intervention on health outcomes (injurious falls including fractures) and costs-outcomes of great clinical and health policy importance. To conduct this research, we have assembled an experienced team of investigators whose skills include health services research, clinical care of falls, health economics, statistics, and use of Medicare claims data. The study will be guided by an Advisory Panel consisting national experts in falls interventions, geriatrics, and quality improvement. The proposed study's significance lies in testing whether the unequivocal success in changing physicians' behavior to improve quality of care for falls translates into improved clinical outcomes and decreased health care costs. If this linkage is valid, it would provide strong support for widespread dissemination of the ACOVE- 2 model through vehicles such as the Patient-Centered Medical Home. PUBLIC HEALTH RELEVANCE: Each year approximately 1/3 of older adults fall and approximately 10% of these falls result in major injuries including hip fractures. In a controlled trial, the ACOVEprime project using the ACOVE-2 practice redesign intervention resulted in a 58% improvement in the quality of falls care compared to control practices. The proposed study will examine the linkages between these improvements in process of care and falls outcomes and costs, which will provide strong support for dissemination of this practice redesign intervention into primary care nationwide.

Relevance to Public Health Each year approximately 1/3 of older adults fall and approximately 10% of these falls result in major injuries including hip fractures. In a controlled trial, the ACOVEprime project using the ACOVE-2 practice redesign intervention resulted in a 58% improvement in the quality of falls care compared to control practices. The proposed study will examine the linkages between these improvements in process of care and falls outcomes and costs, which will provide strong support for dissemination of this practice redesign intervention into primary care nationwide.