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What is the best way to prevent falls? How do we know? Just because it’s the newest, is it necessarily the best?
Some answers to these questions are starting to emerge through increased emphasis on comparative effectiveness research. According to the Institute of Medicine, health experts and policymakers anticipate that comparative effectiveness research will yield greater value from America's health care system and better outcomes for patients. Comparative effectiveness research weighs the benefits and harms of various ways to prevent, diagnose, treat, or monitor clinical conditions to determine which work best for particular types of patients and in different settings and circumstances. Study results can help consumers, clinicians, policymakers, and purchasers make more informed decisions, ultimately improving care for individuals and groups.
This effort to compare the effectiveness of various interventions has been led by the US Agency for Healthcare Research and Quality (AHRQ), which was mandated by Congress under the Medicare Modernization Act of 2003 to conduct research with a focus on outcomes, comparative clinical effectiveness, and appropriateness of devices. This initial effort was expanded under the American Recovery and Reinvestment Act of 2009 to include an addition $1.1 billion in research on comparative effectiveness research. Two organizations, the Institute of Medicine and the Federal Coordinating Council for Comparative Effectiveness Research, were tasked with defining and prioritizing research needs based on extensive public comment.
In June 2009, the initial prioritization of these efforts was released by the Institute of Medicine’s Committee on Comparative Effectiveness Research Prioritization. This committee narrowed an initial list of 1,268 individual topics to a final list of 100, grouped in quartiles. Individual projects are not ranked within quartiles.
Fall interventions were included in the top quartile. IOM’s specific recommendation is to “compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk.” This comes as welcome news to practitioners who have struggled for years with costly and ineffective intervention methods against a backdrop of suit-happy attorneys. According to the insurance industry, fully 75% of claims against hospitals involve allegations of falls that they claim should have been prevented, and for which Medicare will no longer reimburse.
What does that mean for consumers and healthcare facilities? Eventually it should mean more informed decision-making with regard to effective fall interventions, better outcomes for each dollar spent, and better defense against lawsuits alleging no falls should ever occur in a health care facility. |
