Integrated Healthcare and Falls PreventionHAROON KASIM

MEDICAL HOSPITALIST

ACUTE ASSESSMENT UNIT - HORNSBY KURIN GAI HOSPITAL

Why FallsSignificant cause of harm to older people

The rate, intensity and cost of falls identify them as a national safety and quality issue

Estimated costs to the health system around 560 million in 2006/07 * -- likely to much higher now

Expenditure likely to triple by 2051*

Many of the risk factors for falls (eg delirium or balance problems) will have wider benefits beyond falls prevention.

* The Incidence and Cost of Falls Injury Among Older People in NSW 2006/07 . NSW Health

Integrated Care StrategyAIM : To facilitate a shared vision for aged care health service across acute and community health care settings towards enabling timely access to care and to empower other services to deliver appropriate care as close to home as possible. and prevent hospital readmissions.

RIGHT Patient RIGHT PLACE RIGHT TimeRight Patient : Identifying patients at risk through baseline data collection

Right Place and Right time: Enabling community based interventions and preventing hospital admission through ◦ Ongoing personalized risk assessment through use of biometric sensors

◦ Facilitating carer / consumer / provider engagement and dialogue through use of telehealth

Other Potential BenefitsFacilitates consumer engagement i.e patients, families and carer education

Progressive Data Collection could enable clinical decision support systems and machine learning

Role for collaboration Private Sector / Health insurer engagement on account enhanced ability to predict and manage falls risk

Enables data mining / application of big data analytics ,facilitates patient centered outcomes research and inter-professional collaborative learning -- helps partner with universities , specialist colleges

Proposed Design

Participants Residents of low level residential aged care facilities with one or more falls

Community dwelling older people aged 65 and above with one or more falls

? All participants must be mobile able to walk 20 metres without a walking aid

MethodsData Collection across community / acute settings with the patient centered focus

Ongoing monitoring of fall risk through use of biometric sensors

Carer / Consumer engagement to prevent admissions by levergaing telehealth

Written informed consent prior to inclusion

Ethical approval

Baseline Data CollectionDemographic information : Gender, Martial Status, Ethnicity ,Social Supports, living circumstances,

General Health : Pre- existing medical conditions ,medications, previous falls

Physical and Functional Assessments : PPA, SPPB , TUG, IPEQ, Hand grip dynamometer

Neuropsychological assessment : Mini-Cog, ACE-III , Trail Making Test , Digit Symbol Coding Test, Digit Span Backward Test , Attention Network Test, Single Task Measure

Ongoing MonitoringSensor Based Assessments : Balance tests ( Semi-tandem / Near Tandem/ Tandem Stance) , Sit to stand test ( strength, power, balance) , stepping reaction time , hand reaction time

Telehealth and Early InterventionTelehealth to facilitate early community based intervention through greater engagement of consumers , carers and providers

User Acceptance SurveysPatient Self Administered Questionaries' : ◦ WHODAS ( Ax general Health) ,

◦ PHQ-9 ,

◦ EQ - 5D-5L,

◦ Icon FES

Patient Centred Cloud

Integrated Care Framework - Multi sector information access enabling collaborative decision making

Acute care and Specialist Services

Outcome MeasuresSelf Controlled Case series to compare

◦ Primary end points : ED presentations before and after introduction of Integrated Care Strategy

◦ Secondary end points :◦ Patient Reported Outcomes : WHODAS ( Ax general Health) , PHQ-9 , EQ - 5D-5L, Icon FES

◦ ? Hospitalizations ,Hospital Length of Stays ,Transition to higher level of care

◦ User Acceptance

◦ Stakeholder Feasibility studies -- Stakeholder

Some Potential BarriersGovernance structures for data sharing

Issues around data ownership