Does the New Fall- and Fracture Prevention Initiative in Oslo Have Effect?

Does the Improved Coordination of Care for Fall- and Fracture Prevention in Oslo Have Effect on the Rate of Hip Fractures, Need of Nursing Homes or Death?

The goal of this controlled before and after study is to evaluate a new patient pathway for patients 65 years and older who have suffered a fall injury.

The main questions the study aims to answer are whether this preventive initiative with improved care coordination reduces risk of subsequent hip fractures, admittance to nursing homes or death.

Researchers will compare two boroughs in Oslo who implemented the new patient pathway with the 13 other boroughs who did not reorganize their follow-up, but continued their care as usual.

Study Overview

• Status: Active, not recruiting
• Conditions: Hip Fractures; Fall Injury
• Intervention / Treatment: Other: Implement coordination of care with multifactorial falls- and fracture risk assessment and tailored intervention

Detailed Description

The study is an evaluation of a new patient follow-up for fall prevention in Oslo with improvement of coordination of care for elderly at risk of fall injuries.

The intervention were introduced to the boroughs of Nordstrand and Østensjø, which are compared to the other 13 boroughs of Oslo in this controlled before and after study.

THE COHORT

All persons 65 years and older in Oslo are included in Oslo Fall Cohort and we follow all cohort participants prospectively.

OUTCOME VARIABLES

• Hip fracture
• Long term admittance to nursing home
• Death

TIMELINE

The investigators have defined the following dates as the start of intervention:

1. Start of intervention in Nordstrand borough is set to January 1, 2015.
2. Start of intervention Østensjø borough is set to September 1, 2016.

In the main analysis, fallers from the two intervention boroughs, Nordstrand and Østensjø, will be compared with fallers from the control boroughs during the intervention. Any differences between the intervention and control boroughs before the intervention started will be taken into account.

Data on all participants are available from 2010, and the participants will be followed from January 2012 until December 2019.

For each analysis, persons with a hip fracture or living in a nursing home at baseline will be excluded.

The analysis in the evaluation is based on registry data and no analysis relating the intervention to the outcomes has been done before registration in clinicaltrials.gov.

• Study Type: Observational
• Enrollment (Actual): 121000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Total population in Oslo 65 years or older in the period 2012 - 2019.

Description

Inclusion Criteria:

• 65 years or older
• Living on Oslo, Norway in the period January 1. 2012 - December 31. 2019

Exclusion Criteria:

• Hip fracture before baseline
• Living in nursing home at baseline

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
FALLERS IN THE INTERVENTION BOROUGHS; Fallers 65+ years from the borough of Nordstrand from January 1. 2015 Fallers 65+ years from the borough of Østensjø from September 1. 2016 Fall injury will be included as a time-varying exposure variable. The individuals are all registered as non-fallers until they are registered with a fall injury in the NPR database, when they shift status to fallers.	Other: Implement coordination of care with multifactorial falls- and fracture risk assessment and tailored intervention; Other Names: Needs assessment and user involvement; Casefinding with identifying high risk individuals; Single point of entry to care in the boroughs; Cross sectoral plan for follow-up with role clarification; Interdisciplinary teams; Tools for multifactorial falls and fracture risk assessment (checklists for GP, home visits, injury clinic, osteoporosis); Information sharing; Primary and specialist care referral pathways; Targeted interventions (Ex: exercise, home safety, osteoporosis treatment, deprescribing, medical assessment); Champions to create enthusiasm and carry the intervention forward; Collaborative education of health professionals; Technology enablers in the electronic patients records
FALLERS IN THE CONTROL BOROUGHS; Fallers 65+ years from all the 13 other boroughs of Oslo. Fall injury will be included as a time-varying exposure variable. The individuals are all registered as non-fallers until they are registered with a fall injury in the NPR database, when they shift status to fallers.
NON-FALLERS; All non-fallers 65+ years from all Oslo boroughs.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hip fracture	A new hip fracture registered in the Norwegian Patient registry	2012-2019
Admission to nursing home	Long-term admission to nursing home	2012-2019
Death	Total mortality	2012-2019

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subsequent fall injuries	Subsequent falls that result in injuries registered in the Norwegian Patient Registry	2012-1019

Collaborators and Investigators

• Sponsor: Norwegian Institute of Public Health
• Collaborators: University of Oslo; Oslo University Hospital; Oslo Municipality
• Investigators: Study Director: Gro Idland, PhD, Municipality of Oslo, Department of Health

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2012
• Primary Completion (Actual): December 31, 2019
• Study Completion (Anticipated): December 1, 2024

Study Registration Dates

• First Submitted: December 13, 2022
• First Submitted That Met QC Criteria: January 9, 2023
• First Posted (Estimate): January 11, 2023

Study Record Updates

• Last Update Posted (Estimate): January 11, 2023
• Last Update Submitted That Met QC Criteria: January 9, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: RCN296587; 296587 (Other Grant/Funding Number: The Research Council of Norway)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No