ProCare’s Fall Collaborative: Preventing Falls, Maintaining Community Independence And Reducing Costs

Claims from falls cost Aotearoa New Zealand more than $1.5 billion every year, a figure which has increased year on year since 2015 according to ACC*. Recognising this huge burden on individual patients, whānau, and ultimately the healthcare sector, leading healthcare provider ProCare recently dedicated one of its Better Together Collaboratives to falls prevention in a bid to identify older people most at risk of falls and refer them to strength and balance training.

Dr Sue Wells, Associate Clinical Director for Population Health at ProCare says, “Around a third of over 65s will suffer a fall every year - of these individuals, around 4% end up in hospital and 1% suffer a hip fracture**. For what in many cases can be a preventable injury, a fall can have significant consequences for the individual, particularly for maintaining activities of daily living and requiring increased whānau support and rehabilitation in the community. For some older people, a fall may signal the end of independent living and necessitate moving into aged residential care.

“There is strong evidence that strength and balance-based exercises reduce falls by up to 42% and this intervention may be the most cost-effective approach to fall prevention at a population level***,” continues Dr Wells.

ProCare’s Better Together Collaboratives are an evidence-based quality improvement methodology bringing together teams from different general practices to work in a structured way to improve aspects of their service to patients. They involved learning about best practice, quality improvement tools, skills and change ideas, as well as practice staff sharing their experiences of making improvements in their local settings.

“Our Better Together Collaborative devoted to falls prevention had great results. Those who participated in the collaborative increased their completion of falls risk assessments by 11 percentage points compared to a 4 percentage point increase for the rest of the network,” continues Dr Wells.

“Most pleasingly, we saw an 18 percentage point increase for Māori and 10 percentage point increase for Pacific in falls risk assessment,” she continues****.

“Using falls assessments helps doctors understand the root cause of any potential falls, from physical ability, underlying medical conditions or home safety. Taking preventative measures such as exercising regularly, reviewing medication, assessing footwear, and getting a patient’s eyesight checked can all contribute to reducing the risk of our elderly patients having a bad fall and needing medical attention,” she says.

“Once the falls assessment has been undertaken, then doctors can refer onto strength and balance training or other specialists or programmes that can cater to the patient’s specific needs,” she concludes.

*ACC injury from falls data: https://www.acc.co.nz/newsroom/media-resources/injuries-from-falls/

** https://www.healthnavigator.org.nz/health-a-z/f/falls-and-falls-prevention/

*** Stanmore, E.K., Mavroeidi, A., de Jong, L.D. et al. The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC Med 17, 49 (2019). https://doi.org/10.1186/s12916-019-1278-9

**** The cohort for this collaborative looked at the percentage of Māori and Pacific patients aged 65+ and everyone else aged 75+ years who had a falls risk assessment recorded in the PMS in the last 12 months. Overall, the 11 collaborative practices, representing a population of more than 5000 patients 65 plus, increased their completion of falls risk assessment for this population from 1% to 12% (an 11% total increase) whereas, the rest of the network 2% to 6% (4% absolute increase). Any move upward in these figures is considered significant.

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