Decision support for improving fall-management in elderly patients in the primary care setting.

Problem:

Falls, and balance and mobility problems in older ages form a serious health concerns for both elderly patients and health care systems. It is known that fall detection is under detected. Elderly in particular the vulnerable elders are in need of continuous assessment and they need receiving integrated and specific care adapted to their situation.

The fall set of quality indicators (QIs) of the ACOVE (Assessing Care Of the Vulnerable Elders) is a comprehensive instrument for measuring quality of fall-care and improving fall management for elderly people. However, the indicators are still used to assess, rather than improve, care delivery.


Objective:

The primary objective in the PROFIT-PC (Prevention Of Falls using Information Technology - Primary Care) study is the systematic improvement of fall prevention and management at primary care for older persons by increasing adherence to a carefully selected set of fall QIs.


Approach:

After the selection of the fall QIs we translated them into formal clinical rules for processing by a computer. The formal rules are then employed in a clinical decision support system (CDSS) that pro-actively reminds and alerts GPs to make the decisions consistent with the rules.

Intervention:
All the GPs will receive decision support pertaining to the selected fall clinical rules.
The reminders and alerts are not meant to be intrusive: They appear in a "ToDo" list which will be displayed at the edge of the computer screen of the GP. When GPs comply to a rule they will receive positive feedback. Color-coding will be used to display the status of the rule in terms of adherence.



Primary outcome:

Adherence to the selected clinical rules. This will be measured based on the (1) pass rates of the individual rules (2) general pass rates regardless of specific rules

User-driven computerized decision support provided to general practitioners will improve their adherence to clinical rules pertaining to fall management for elderly patients.

Measurements are automatically collected by the computer as soon as they become available. We will measure adherence at the end of the study.

A subset of fall clinical rules originating from the ACOVE (Assessing care of Vulnerable Elders), complete set of rules which was translated to the Dutch settings, has been selected based on surveys and focus groups with General Practitioners (GPs).
The intervention consists of helping GPs to better document fall history for elders (65 years old and older) and providing, when needed, alerts and reminders based on the selected clinical rules.

The reminders and alerts are not meant to be intrusive: they appear in a "ToDo" list which will be displayed at the edge of the GP’s computer screen. Color-coding will be used to display the status of the rule in terms of adherence.