Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area

OBJECTIVES: To report on the penetration of, and identified barriers to and facilitators of, efforts to incorporate evidence-based fall risk assessment and management into clinical practice throughout a defined geographic area. DESIGN: Dissemination project. SETTING: North central Connecticut. PARTICIPANTS: Hospitals, home care agencies, primary care providers, and outpatient rehabilitation facilities. INTERVENTION: Multiple professional behavior-change strategies were used to encourage providers to incorporate evidence-based fall assessment and management into their practices. MEASUREMENTS: Penetration of dissemination efforts over 36 months; barriers and facilitators identified by provider working groups during the first 2 years of the project. RESULTS: All seven hospitals and 26 home care agencies in the area, 119 of 130 rehabilitation facilities, and 138 of 212 primary care offices participated. Most provider working groups expressed similar barriers and facilitating factors. Reported barriers specific to fall risk management included lack of awareness of fall morbidity and preventability, perceived lack of expertise and Medicare coverage, inadequate referral patterns among providers, and lack of a federal mandate for physicians. Facilitating factors specific to falls included the opportunity to market new services and to develop new networks of professional relationships across disciplines and the Medicare mandate that home care agencies focus on functional outcomes. CONCLUSION: Dissemination efforts showed notable successes as well as challenges. Although many of the barriers were general to diffusing new practices, several were specific to fall assessment and management that span disciplines and sites. Project results have implications for efforts to diffuse evidence-based practices for multifactorial geriatric conditions such as falls.