Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial

Alessandro Giordano, Gian Pietro Bonometti, Fabio Vanoglio, Mara Paneroni, Palmira Bernocchi, Laura Comini, Amerigo Giordano, Alessandro Giordano, Gian Pietro Bonometti, Fabio Vanoglio, Mara Paneroni, Palmira Bernocchi, Laura Comini, Amerigo Giordano

Abstract

Background: Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored.

Methods and design: This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios.

Discussion: To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings.

Trial registration: ClinicalTrials.gov ( NCT02487589 ).

Keywords: Cost-effectiveness; Fall; Information Communication Technologies; Prevention; Trial.

Figures

Fig. 1
Fig. 1
Design of the study

References

    1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;(4):CD000340.
    1. Close J, Ellis M, Hooper R. Prevention of falls in elderly trial (PROFET): a randomised controlled trial. Lancet. 1999;353:93–7. doi: 10.1016/S0140-6736(98)06119-4.
    1. Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly. J Manag Care Pharm. 2005;11:307–16.
    1. Meerding WJ, Bonneux L, Polder JJ, Koopmanschap MA, van der Maar PJ. Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study. BMJ. 1998;317:111–5. doi: 10.1136/bmj.317.7151.111.
    1. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680. doi: 10.1136/bmj.328.7441.680.
    1. Robertson MC, Gillespie LD. Fall prevention in community-dwelling older adults. JAMA. 2013;309:1406. doi: 10.1001/jama.2013.3130.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.
    1. Elley CR, Robertson MC, Garrett S, Kerse NM, McKinlay E, Lawton B, et al. Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at risk older adults. J Am Geriatr Soc. 2008;56:1383. doi: 10.1111/j.1532-5415.2008.01802.x.
    1. Tinetti ME. Multifactorial fall-prevention strategies: time to retreat or advance. J Am Geriatr Soc. 2008;56:1563. doi: 10.1111/j.1532-5415.2008.01800.x.
    1. Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: randomised controlled trial. BMJ. 2001;322:697–9. doi: 10.1136/bmj.322.7288.697.
    1. Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ. Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health. 2001;55:600–6. doi: 10.1136/jech.55.8.600.
    1. Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: controlled trial in multiple centres. BMJ. 2001;322:701–4. doi: 10.1136/bmj.322.7288.701.
    1. Salkeld G, Cumming RG, O’Neill E, Thomas M, Szonyi G, Westbury C. The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Aust N Z J Public Health. 2000;24:265–71. doi: 10.1111/j.1467-842X.2000.tb01566.x.
    1. Smith RD, Widiatmoko D. The cost-effectiveness of home assessment and modification to reduce falls in the elderly. Aust N Z J Public Health. 1998;22:436–40. doi: 10.1111/j.1467-842X.1998.tb01410.x.
    1. Otago Exercise Programme. []. Accessed 29 Nov 2016.
    1. Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Pratical implementation of an exercise-based falls prevention programme. Age Ageing. 2001;30:77–83. doi: 10.1093/ageing/30.1.77.
    1. Brigoni P, De Masi S, Di Franco M, Rinonapoli G, Romanini E, Sampaolo L, et al. Prevenzione delle cadute da incidente domestico negli anziani. PNLG 13-Programma Nazionale Linee Guida(PNLG) 2007.
    1. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance Score and a history of falls in hospital predict recurrent falls in the 6 Months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87:1583–9. doi: 10.1016/j.apmr.2006.09.004.
    1. Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr. 2003;61:777–81. doi: 10.1590/S0004-282X2003000500014.
    1. Elmo A, Ruggiero C, Mariani T, Gugliotta R, Gasperini B, Serra R, et al. Validazione della FES-I e della FES-I breve in anziani viventi in comunità. G Gerontol. 2010;58:259–63.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaning and instrumental activities of daily living. Gerontologist. 1969;9:179–86. doi: 10.1093/geront/9.3_Part_1.179.
    1. The prevention of falls in later life A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull. 1987;34 Suppl 4:1–24.
    1. Drummond MF, Sculpher MJ, Thorrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press; 2005.
    1. Balestroni G, Bertolotti G. [EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. Monaldi Arch Chest Dis. 2012;78(3):155–9. [Article in Italian].
    1. Goossens ME. Rutten van Molken MP, Vlaeyen JW, van der Linden SM. The cost diary: A method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol. 2000;53:688–95. doi: 10.1016/S0895-4356(99)00177-8.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever