Older fallers Injury, Occupational Diseases, Poisoning
Conditions
Interventions
The intervention being evaluated is an IT innovation of CDS software on a hand-held Tablet PC for use on scene by ambulance crews to make decisions about the clinical and social care needs of patients
2) decision-support guidance to assess and plan care for older fallers
3) the hardware and software and 4) referral to community based care providers. The package will be evaluated as a whole, in line with the recommendations of the MRC for evaluating complex interventi
Sponsors
Department of Health Information and Communication Research Initiative (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 999 calls for patients over 65 in Wales and England attended by a study paramedic and classified by them as having fallen
Exclusion criteria
Exclusion criteria: In order to maximise generalisability of findings to this group of frail patients with complex needs no patients will be excluded due to other conditions or competence
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Patients will be tracked through the 999 system, A&E departments, GPs and coroners to identify further contacts with these services (or death) following a fall within one month. Referrals will be followed up and contacts with other service providers recorded. Quality of life of patients and carers, self-reported falls and independence will be followed up by questionnaire, to be administered by post (or interview, where necessary), including the SF12 , EQ5D and the CGI at 1 month; patient satisfaction will also be followed up at 1 month with the Quality of Care Monitor. Despite using several validated outcome measures, care has been taken to select brief tools and efforts will be made to keep the questionnaire as short as possible in order to minimise the burden on respondents and to maximise response rate. Job cycle times will be recorded for all calls meeting the study inclusion criteria, from routine ambulance records. | — |
Secondary
| Measure | Time frame |
|---|---|
| Health economics: The economic analysis will estimate the costs of providing the new intervention, the consequences of the scheme for the wider NHS (eg A&E attendances, inpatient admissions) and the costs to patients and families. Data on the use of the health service resources will be collected for each patient using a combination of paramedic records, routine hospital records (for hospital events) and patient-completed questionnaires. Costs will then be calculated using unit-costs estimated through a micro-costing study within the trial. Direct costs to the NHS will be assessed using data logged as a part of routine practice and from resource utilisation recording sheets, together with reference to patient records and discussions with relevant finance staff. The EQ5D will also be used to estimate the quality adjusted life years (QALYs) gained from the intervention and an incremental cost-per-QALY estimated. These ratios will be presented along with their associated cost-effectiveness acceptability curves. Sensitivity analysis will be undertaken to assess the robustness of the results to changes in the configuration of the scheme and other health service costs. Qualitative: A subset of 10 older people who fall and are attended by ambulance crews using the new technology at each study site (20 in total) will be interviewed in more depth, using a semi-structured interview schedule to ascertain their views and preferences regarding the service they received. Where possible, to minimise disruption and number of visitors, these interviews will be carried out by the community based providers who visit the older people following referral from the 999 service. The study researchers will train these providers in qualitative interviewing techniques to ensure that standards of data collection are maintained. Focus groups (n = 6) will be carried out with paramedics from the intervention and control groups following the trial, and with other stakeholders based in other s | — |
Countries
United Kingdom
Outcome results
None listed