Development and pilot of a rapid-response, virtual, fall-risk assessment and management service for community-dwelling aged care clients.

A mixed-methods three-phase study, with each phase informing subsequent phases has been selected to address the study aim (develop and pilot test a rapid-response falls risk assessment and management service tool). Stage 1: Community aged care staff and Allied Health Professionals (AHPs) focus groups (total duration: 2 months) - DEVELOPMENT STAGE Focus groups will be conducted online (via Microsoft Teams) by a member of the research team. Participants will be HammondCare at Home (HC@H) clinical and client care managers, and HammondCare Restorative Care Team AHPs. Multiple focus groups will be scheduled over a 4 week period to accommodate all participants. However, each participant will only attend one focus group, which will run for 1 hour. The focus groups will discuss findings from a scoping literature review, the key topics will be focused on current evidence on falls risk assessments and interventions for older adults, and virtual delivery of healthcare services in the community. The focus groups will be conducted to ensure that the rapid-response falls risk assessment and management service tool is not only theoretically sound but also practically applicable and able to be effectively delivered in the community aged care context, including within the scope of practice of community aged care staff (care worker, clinical manager, client care managers) and AHPs. Strategies used to monitor adherence to intervention will not be required at this stage as it is a developmental stage, participation is voluntary, and participants are only required to attend one focus group. Stage 2: Rapid-response falls risk assessment and management service tool development (total duration: 2 months) - DEVELOPMENT STAGE This stage focuses on development of the two components of the tool, building on insights from Stage 1: (i) A falls risk stratification algorithm that can be used by community aged care staff to identify deteriorating clients at an increased risk of falls. This could be either a paper-based or a dynamic questionnaire built into HC@H’s client management software. (ii) Collation of a focussed set of evidence-based falls risk assessments and interventions that can be incorporated into an AHP assessment and able to be conducted virtually with the client (with the support of a HC@H staff member present in the home if needed). Once the tool has been developed, participants (i.e. HC@H clinical and client care managers, and HammondCare Restorative Care Team AHPs) will be asked to work through real-world case scenarios using either the falls risk stratification algorithm (HC@H care workers and clinical and client care managers) or the virtual AHP falls risk assessment (HammondCare Restorative Care Team AHPs). This activity will take 30 minutes to complete, each participant will only have to complete this activity once. Possible scearios will include falls incidents (e.g. older adult falls outside whilst completing a functional task, older adult has a near miss fall whilst the HC@H csre worker is present) and changes/deterioration in mobiltiy or function (e.g. carer of the older adult reports a deterioation in mobility when out in the community. older adult reports an increased concern about falling when completing a household task). Participate will then complete one online interview (via Microsoft Teams) one-to-one with a member of the research team to discuss the component of the tool they reviewed and their experience in completing the real-world scenario. This activity will take 30 minutes to complete. Strategies used to monitor adherence to intervention will not be required at this stage as it is a developmental stage, participation is voluntary, and participants are only required to attend one interview. Stage 3: Pilot of the rapid-response falls risk assessment and management service tool (total duration: 4 months) - INTERVENTION STAGE This stage will assess the practicality and effectiveness of the developed tool in a community aged care service, incorporated into routine practice (when indicated). The falls risk stratification algorithm will be pilot tested by HC@H staff and clients; the virtual AHP falls risk assessment to be pilot tested by HammondCare Restorative Care Team AHPs and clients, with the support of a HC@H care worker or manager being present in the home. Examples of support may include assistance with use of the technology to access the virtual assessment, supervision when completing relevant assessment tasks, and further explanation of how to complete an assessment task or intervention recommendation. The virtual assessment will be audio recorded. Deidentified versions of the recordings will only be used to help develop Artifical Intlligence (AI) software that could potentially automate note taking during clinical assessments. Audio recordings are required to accurately capture the clinical dialogue and context necessary for the development and validation of the AI note taking software. Manual transcription or summary notes would not provide the level of detail required for this purpose. This process aims to improve the efficiency and accuracy of clinical note taking through the validation of the AI note taking software. There are three AI software companies involved in the development and validation process: Crayon (supported by Amazon Web Services), BJSS (supported by Amazon Web Services), and QTX (supported by Microsoft). All companies are based within Australia, all processing is completed on shore within Australia, and data will be securely saved on safe, HammondCare-managed cloud platforms (Azure for Crayon and QTX, and Amazon Web Services for BJSS). HC@H staff and HammondCare Restorative Care Team AHPs will recevie training on the use of the rapid-response falls risk assessment and management service tool, and how to incorporate it into routine practice. Training sessions will be scheduled during a 2-week period prior to recruitment for Stage 3. Participants will only be required to attend one training session in this time. The training sessions will be conducted by a member of the research team online (via Microsoft Teams). The sessions will be recorded to allow participsants to re-watch them as required during this Stage. They will also be proivded with a training pack (via email or saved to a HammondCare shared folder) they can refer to that summarises the key points of the training session. The piloting of both the falls risk stratification algorithm and virtual AHP falls risk assessment will include a focus on the clinical utility, user acceptance, and ability for the rapid-response falls risk assessment and management service tool to be incorporated into routine practice. Pilot data will be collected from clinical records, an anonymous online survey completed by HC@H staff and HammondCare Restorative Care Team AHPs at the end of Stage 3, and an online Patient-Reported Experience Measure (PREM) survey (a paper-based alternative will be provided if needed/request) completed by HC@H clients after completion of their participation in Stage 3. The PREM survey will not be anonymous to allow for linkage with client demographic and clinical outcome data during the analysis stage. Clinical records and online surveys will also be reviewed to assess adherence and fidelity to the rapid-response falls risk assessment and management service tool. Once the virtual AHP falls risk assessment has been completed, the AHP’s recommendations will be reported back to the client's HC@H clinical or client care (as appropriate) manager. Potential options may include a virtually delivered falls prevention program, a face-to-face AHP visit, liaison with GP or other usual care, which are all currently available services from HammondCare and are not the subject of this research (which is focussed on the development and pilot of the falls risk stratification algorithm and the virtual AHP falls risk assessment).