Evaluating Projects of a NORC Program
Preventing Falls: Evaluating the Project and Lessons Learned
Almost from the moment it began to design its falls prevention program, Deepdale CARES also planned for its evaluation. Guided by the logic model, staff laid out each step of the falls prevention protocol, which was intended to meet twin goals:
Clinical goal: Decrease the risk factors associated with falls.
Structural goal: Increase communication and cooperation between NORC program staff and local primary care physicians in private practice.
A work plan listed key activities, the dates they were started and completed, desired outcomes, and the person responsible for making sure that each step happened. At regularly scheduled meetings, staff reviewed the plan to make sure the work was on target.
NORC program staff also created a Clinical Tracking List to follow client progress. This provided a simple and consistent way to collect data.
By assessing 93 older residents before the prevention protocol was in place, Deepdale CARES had baseline data on which to build the evaluation. Baseline information included on the Tracking List included the client name or record number; the date the initial assessment was conducted; the assessment score; and whether the individual was considered at risk.
After the initial assessment was completed and a care plan had been developed, the Tracking List was used to record each recommendation in the care plan; the intended follow-up by NORC program staff, and information on compliance and further follow-up.
Initial survey results indicated that 80% of the participants were at risk for falls. Risk factors included a history of falls; use of certain medications; inability to walk independently; a history of emotional problems; sensory deficits; and impaired judgment.
When the same residents were reassessed six months after the falls prevention protocol was in place, 60% of them were found to be at risk, a significant decline.
Improvements in patent-provider communication proved somewhat harder to measure, but 29 community physicians requested one or more follow-up services for their patients and physicians initiated a significant amount of communication about falls with NORC program staff.
Staff concluded that the falls prevention program helped to put risk-reduction strategies into routine medical practice, and successfully involved physicians in planning for the care of their patients. But along the way, they encountered a few surprises.
“In our naiveté we thought the majority of seniors in Deepdale would have a lot of doctors in common, but that was wrong,” said the Y's Karen Schwab. That meant a much larger outreach effort was required to involve all of the community physicians who served participating residents.
The time constraints on busy physicians proved to be another challenge, with doctors repeatedly cancelling the breakfast meetings they had scheduled to talk about the falls prevention program. Eventually, NORC program staff discovered it was more useful to speak with the nurse in the office, who would then brief the doctor.
Another unexpected outcome was that patients became more empowered to talk to their physicians. “Our emphasis had been on promoting communication between doctors and our staff, but we found out there was a lot the clients needed to be doing, too,” said the Deepdale nurse Dale Chaikin.
Educating seniors about how to talk to their doctors became part of the community education piece of the project. “Seniors told us they were realizing they needed to go into the doctor’s offices with questions written down and with someone to hear what the doctors were saying,” says Ms. Chaikin. “ They were really learning how to be a part of the process.” Continued...