Fall Injury
Conditions
Keywords
Fall injury hospitalization, Fall injury emergency department visit, Fall injury death
Brief summary
An important challenge for the field of injury prevention and control is the translation of research findings into effective community-based prevention programs and practices. The National Center for Injury Prevention and Control believes that dissemination research can overcome this challenge by providing insight into the structures and methods needed to translate injury control research into everyday practice. The proposed dissemination research study will rigorously assess whether the use of a facilitative system can successfully bridge the gap between injury prevention and control research and the implementation of evidence-driven, community-based programs, policies, and practices. The facilitative system links communities with academic partners to provide communities with the skills and resources needed to help facilitate the community health improvement process. The system identifies what assets are available within communities, as well as the skills and resources needed to work through the community health improvement process. The facilitative system will then provide technical assistance, best practices guides, and direct consultation in carrying out all phases of the community health improvement process. This information is designed to increase community capacity in community assessment, coalition development, accessing and interpreting local injury prevention data, searching and selecting evidence-based research, and program planning and evaluation. The study will use a randomized community trial design to evaluate fall injury occurrence and process measures of program implementation in three groups of communities: * a control group receiving no special resources or guidance related to fall injury prevention or the community health improvement process; * a Standard Program group receiving modest funding to implement an evidence-based fall prevention program in their local community; * a Facilitative System group receiving facilitative system support in addition to the resources provided the Standard Program group. We hypothesize that the Facilitative System program will be more effective at: * reducing fall-related injuries in the elderly; * building community coalitions that are goal-oriented and sustainable; * implementing community-based, evidence-driven fall prevention programs that are both tailored to the community needs and yet faithful to empirically-tested fall prevention research studies
Interventions
OTHERfacilitative system
The facilitative system links communities with academic partners to provide communities with the skills and resources needed to help facilitate the community health improvement process. The system identifies what assets are available within communities, as well as the skills and resources needed to work through the community health improvement process. The facilitative system will then provide technical assistance, best practices guides, and direct consultation in carrying out all phases of the community health improvement process. This information is designed to increase community capacity in community assessment, coalition development, accessing and interpreting local injury prevention data, searching and selecting evidence-based research, and program planning and evaluation.
OTHERStandard Program
a Standard Program group receiving modest funding to implement an evidence-based fall prevention program in their local community;
Sponsors
Medical College of Wisconsin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Communities interested in participating
Exclusion criteria
* Existing facilitative system in community
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency Department and In-patient Hospitalization for Fall Injury | 2007-2008; 2010-2011 | Rates of fall injury diagnoses per 100 person-years (P-Y) were computed for the communities in each of the study groups for a 2 year baseline period, 2007-2008, and for a 2 year follow-up period corresponding to years 2010-2011. Change in fall injury rates and their 95% confidence intervals (CI) are reported. A mixed-effects Poisson regression model was used to test the presence of an interaction effect on the fall rate between study group and time period (baseline or follow-up). The test is intended to detect a differential time effect by study group. This model, with main effects for study group and time period and an interaction term, will be referred to as the primary model. Model coefficients and incidence rate ratios (IRR) with 95% confidence intervals (CI) are reported. |
Countries
United States
Participant flow
Recruitment details
20 interested communities were randomized to one of the three groups using a block randomization method, taking into account whether the lead agency was a health department or aging agency and whether the community had 0 or 1 or more Stepping On fall prevention program leaders already.
Participants by arm
| Arm | Count |
|---|---|
| Control a control group of 10 communities and their residents over 65 years of age receiving no special resources or guidance related to fall injury prevention or the community health improvement process; | 12,494 |
| Standard Program a Standard Program group of five communities and their residents over 65 years of age receiving modest funding to implement an evidence-based fall prevention program in their local community;
Standard Program: a Standard Program group receiving modest funding to implement an evidence-based fall prevention program in their local community; | 14,842 |
| Facilitative System a Facilitative System group of five communities and their residents over 65 years of age receiving support in addition to the resources provided the Standard Program group
facilitative system: The facilitative system links communities with academic partners to provide communities with the skills and resources needed to help facilitate the community health improvement process. The system identifies what assets are available within communities, as well as the skills and resources needed to work through the community health improvement process. The facilitative system will then provide technical assistance, best practices guides, and direct consultation in carrying out all phases of the community health improvement process. This information is designed to increase community capacity in community assessment, coalition development, accessing and interpreting local injury prevention data, searching and selecting evidence-based research, and program planning and evaluation. | 7,701 |
| Total | 35,037 |
Baseline characteristics
| Characteristic | Total | Standard Program | Control | Facilitative System |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 35037 Participants | 14842 Participants | 12494 Participants | 7701 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex/Gender, Customized Not collected | NA participants | NA participants | NA participants | NA participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 12,494 | 0 / 14,842 | 0 / 7,701 |
| serious Total, serious adverse events | 0 / 12,494 | 0 / 14,842 | 0 / 7,701 |
Outcome results
Primary
Emergency Department and In-patient Hospitalization for Fall Injury
Rates of fall injury diagnoses per 100 person-years (P-Y) were computed for the communities in each of the study groups for a 2 year baseline period, 2007-2008, and for a 2 year follow-up period corresponding to years 2010-2011. Change in fall injury rates and their 95% confidence intervals (CI) are reported. A mixed-effects Poisson regression model was used to test the presence of an interaction effect on the fall rate between study group and time period (baseline or follow-up). The test is intended to detect a differential time effect by study group. This model, with main effects for study group and time period and an interaction term, will be referred to as the primary model. Model coefficients and incidence rate ratios (IRR) with 95% confidence intervals (CI) are reported.
Time frame: 2007-2008; 2010-2011
Population: Population of residents aged 65 and older for participating communities in each study arm for 2007-2008 baseline period and 2010-2011 follow-up period.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Control | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y, 2007-2008 | 5.8 Fall Injury Rate per 100 person years |
| Control | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y 2010-2011 | 5.8 Fall Injury Rate per 100 person years |
| Standard Program | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y, 2007-2008 | 5.9 Fall Injury Rate per 100 person years |
| Standard Program | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y 2010-2011 | 5.3 Fall Injury Rate per 100 person years |
| Facilitative System | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y, 2007-2008 | 6.1 Fall Injury Rate per 100 person years |
| Facilitative System | Emergency Department and In-patient Hospitalization for Fall Injury | Fall Injury Rate per 100 P-Y 2010-2011 | 5.6 Fall Injury Rate per 100 person years |
p-value: <0.0595% CI: [0.88, 0.95]Mixed Models Analysis
p-value: <0.0595% CI: [0.88, 0.94]Mixed Models Analysis