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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (7)
- Anxiety (1)
- Behavioral Health (1)
- Caregiving (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (3)
- Decision Making (3)
- Depression (1)
- Diabetes (1)
- Elderly (15)
- Electronic Health Records (EHRs) (2)
- Emergency Department (4)
- Evidence-Based Practice (1)
- Eye Disease and Health (1)
- (-) Falls (24)
- Health Information Technology (HIT) (3)
- Hospitalization (1)
- Hospitals (5)
- Injuries and Wounds (7)
- Inpatient Care (2)
- Long-Term Care (2)
- Medicare (2)
- Medication (5)
- Nursing Homes (5)
- Patient Safety (13)
- Prevention (6)
- Primary Care (1)
- Provider (1)
- Quality Improvement (1)
- Quality of Care (1)
- (-) Risk (24)
- Tools & Toolkits (1)
- Young Adults (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedShear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
AHRQ-funded; HS024558.
Citation: Jacobsohn GC, Leaf M, Liao F .
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Herzig SJ, Rothberg MB, Moss CR
Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients.
This study investigated the risk of in-hospital falls among patients receiving medications commonly used for insomnia. This retrospective cohort study was conducted at a large academic medical center from January 2007 to July 2013. Adults admitted for a primary psychiatric disorder were excluded. Medications of interest included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists, trazodone, atypical antipsychotics, and diphenhydramine. Among 225,498 hospitalizations, 37.7% had exposure to at least one of the medication classes of interest with benzodiazepines being the most commonly prescribed. A fall occurred in 1.1% (2,427) of hospitalizations. The rate of falls per 1,000 hospital days was greater among patients with exposure to each of the medications of interest compared to unexposed patients.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Rothberg MB, Moss CR .
Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients.
Sleep 2021 Sep 13;44(9):zsab064. doi: 10.1093/sleep/zsab064..
Keywords: Falls, Medication, Adverse Events, Risk, Hospitals
Hoffman GJ, Tinetti ME, Ha J
Prehospital and posthospital fall injuries in older US adults.
Investigators estimated the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization using national data from 2006 to 2014. Participants in this cohort study included Medicare fee-for-service beneficiaries aged 65 and older from the Health and Retirement Study. The investigators found that an episode-based assessment of fall injury illustrated substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods included sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Tinetti ME, Ha J .
Prehospital and posthospital fall injuries in older US adults.
JAMA Netw Open 2020 Aug 3;3(8):e2013243. doi: 10.1001/jamanetworkopen.2020.13243..
Keywords: Elderly, Falls, Injuries and Wounds, Risk, Hospitalization, Medicare
Bushnell GA, Gerhard T, Crystal S
Benzodiazepine treatment and fracture risk in young persons with anxiety disorders.
This study examined whether benzodiazepine treatment increases fall and fracture risk in young persons as it has been shown to do in older adults. They examined whether children (6-17 years) and young adults (18-24) recently diagnosed with anxiety disorder had an increased fracture risk. A cohort of commercially insured children and young adults who had initiated use of benzodiazepine or SSRIs were followed for 3 months, or until fracture, treatment discontinuation or switching or disenrollment occurred. The cohort consisted of 120,715 children and 179,768 young adults. There was an increased fracture rate found in children, but not young adults.
AHRQ-funded; HS026001.
Citation: Bushnell GA, Gerhard T, Crystal S .
Benzodiazepine treatment and fracture risk in young persons with anxiety disorders.
Pediatrics 2020 Jul;146(1):e20193478. doi: 10.1542/peds.2019-3478..
Keywords: Children/Adolescents, Young Adults, Medication, Falls, Injuries and Wounds, Risk, Anxiety, Behavioral Health
Venema DM, Skinner AM, Nailon R
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.
AHRQ-funded; HS021429.
Citation: Venema DM, Skinner AM, Nailon R .
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
BMC Geriatr 2019 Dec 11;19(1):348. doi: 10.1186/s12877-019-1368-8..
Keywords: Falls, Injuries and Wounds, Patient Safety, Elderly, Risk, Hospitals, Adverse Events
Jones KJ, Skinner A, Venema D
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Researchers evaluated the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. They found that multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
AHRQ-funded; HS024630; HS021429.
Citation: Jones KJ, Skinner A, Venema D .
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Health Serv Res 2019 Oct;54(5):994-1006. doi: 10.1111/1475-6773.13186..
Keywords: Falls, Hospitals, Inpatient Care, Quality of Care, Quality Improvement, Patient Safety, Prevention, Risk
Patterson BW, Jacobsohn GC, Shah MN
Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department.
This study examined development and validation of a pragmatic natural language processing (NLP) approach to identify fall risk in older adults after emergency department (ED) visits. A single center retrospective review using data from 500 emergency department provider notes on older adults age 65 and older were random selected for analysis. The NLP algorithm successfully identified falls in ED notes with over 90% precision, and looks promising to reduce labor-intensive manual abstraction.
AHRQ-funded; HS024558.
Citation: Patterson BW, Jacobsohn GC, Shah MN .
Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department.
BMC Med Inform Decis Mak 2019 Jul 22;19(1):138. doi: 10.1186/s12911-019-0843-7..
Keywords: Adverse Events, Elderly, Emergency Department, Falls, Risk, Patient Safety
Patterson BW, Engstrom CJ, Sah V
Training and interpreting machine learning algorithms to evaluate fall risk after emergency department visits.
This study examined the potential of using machine learning algorithms to evaluate fall risk after an emergency department (ED) visit. They compared several machine learning methodologies for creation of a risk stratification algorithm to predict the outcome of a return visit for a fall within 6 months of an ED visit.
AHRQ-funded; HS024558; HS024342.
Citation: Patterson BW, Engstrom CJ, Sah V .
Training and interpreting machine learning algorithms to evaluate fall risk after emergency department visits.
Med Care 2019 Jul;57(7):560-66. doi: 10.1097/mlr.0000000000001140..
Keywords: Adverse Events, Elderly, Emergency Department, Falls, Risk, Patient Safety
Randolph AC, Lin YL, Volpi E
Tricyclic antidepressant and/or gamma-aminobutyric acid-analog use is associated with fall risk in diabetic peripheral neuropathy.
This study invested whether tricyclic antidepressant and/or gamma-aminobutyric acid-analog (TCA/GABA) use is associated fall risk in older diabetic peripheral neuropathy (DPN) patients. A nationally representative 5% Medicare sample between the years 2008 and 2010 were used, and 5,550 patients with TCA/GABA prescriptions were compared to 22,200 patients without a TCA/GABA prescription. Patients were followed until there was an incidence of a fall or first incidence of a fracture during the follow-up period of up to 5 years. After covariate adjustment, there was a statistically significant increase in falls and fractures for patients using TCAs or GABA-analogs.
AHRQ-funded; HS020642.
Citation: Randolph AC, Lin YL, Volpi E .
Tricyclic antidepressant and/or gamma-aminobutyric acid-analog use is associated with fall risk in diabetic peripheral neuropathy.
J Am Geriatr Soc 2019 Jun;67(6):1174-81. doi: 10.1111/jgs.15779..
Keywords: Medication, Diabetes, Elderly, Falls, Injuries and Wounds, Medicare, Risk
Aspinall SL, Springer SP, Zhao X
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
This study investigated the association between taking central nervous system (CNS) medications with the risk of serious falls and hip fractures. Study participants were residents at a Veterans Health Administration (VHA) Community Living Center (CLC) between July 1, 2005 and June 30, 2009. This was a nested case-control study. The investigators concluded that there was a higher risk in those residents receiving 3.0 or more daily CNS medications.
AHRQ-funded; HS023779.
Citation: Aspinall SL, Springer SP, Zhao X .
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
J Am Geriatr Soc 2019 Jan;67(1):74-80. doi: 10.1111/jgs.15603..
Keywords: Elderly, Falls, Injuries and Wounds, Long-Term Care, Medication, Nursing Homes, Patient Safety, Risk
Noureldin M, Hass Z, Abrahamson K
Fall risk, supports and services, and falls following a nursing home discharge.
The purpose of this study was to examine whether the presence of supports and services have an impact on the relationship between fall-related risk factors and fall occurrence following a nursing-home discharge. The study sample was comprised of 1459 participants in the Minnesota Return to Community Initiative, who had been assisted in achieving a community discharge; 15 percent of participants fell within 30 days of nursing-home discharge. A structural equation model was used to determine relationship between emerging latent variables and falls. Results indicated that use of high-risk medications and fall concerns/history had a direct, positive effect on falling. Receiving supports/services did not have a direct effect on falls, but the authors note that it reduced the effect of high-risk medication use on falling.
AHRQ-funded; HS020224.
Citation: Noureldin M, Hass Z, Abrahamson K .
Fall risk, supports and services, and falls following a nursing home discharge.
Gerontologist 2018 Nov 3;58(6):1075-84. doi: 10.1093/geront/gnx133..
Keywords: Adverse Events, Elderly, Falls, Nursing Homes, Risk
Dore DD, Zullo AR, Mor V
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
This study examined the rate of hip fracture in nursing home residents prescribed nonbenzodiazepine hypnotics. A sample of nursing home residents was used and linked to Medicare and Minimum Data Set (2007-2008) data. The rate of hip fracture was higher in residents aged 90 and above, and lower in residents 70 or below. There was no different by sex.
AHRQ-funded; HS022998.
Citation: Dore DD, Zullo AR, Mor V .
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
J Am Med Dir Assoc 2018 Apr;19(4):328-32.e2. doi: 10.1016/j.jamda.2017.09.015..
Keywords: Injuries and Wounds, Medication, Nursing Homes, Long-Term Care, Adverse Drug Events (ADE), Adverse Events, Falls, Risk, Patient Safety
Patterson BW, Repplinger MD, Pulia MS
Using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls after emergency department visits.
This study examined the utility of using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls in elderly patients after emergency department (ED) visits. Individuals aged 65 and older seen in the ED from January 2013 to September 30, 2015 participated in the study. The Hendrich II screen was found to correlate with outpatient falls, but it is likely it would have little utility as a stand-alone fall screen. When the screen was combined with other potential confounders or predictors, the screen performed much better.
AHRQ-funded; HS024558.
Citation: Patterson BW, Repplinger MD, Pulia MS .
Using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls after emergency department visits.
J Am Geriatr Soc 2018 Apr;66(4):760-65. doi: 10.1111/jgs.15299..
Keywords: Elderly, Falls, Risk, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Prevention, Patient Safety, Adverse Events
Cary MP, Hall RK, Anderson AL
Management team perceptions of risks and strategies for preventing falls among short-stay patients in nursing homes.
This study sought to understand and describe strategies reported by members of the nursing home management team used to prevent falls in short-stay nursing home patients. The authors propose interventions that might reduce falls for short-stay patients and could be tested in future research.
AHRQ-funded; HS022134.
Citation: Cary MP, Hall RK, Anderson AL .
Management team perceptions of risks and strategies for preventing falls among short-stay patients in nursing homes.
Health Care Manag 2018 Jan/Mar;37(1):76-85. doi: 10.1097/hcm.0000000000000192..
Keywords: Falls, Nursing Homes, Prevention, Provider, Risk
Dykes PC, Duckworth M, Cunningham S
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. The investigators examined strategies to integrate this evidence into clinical practice. They concluded that engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. They address and detail barriers to adoption of the protocol to provide guidance for spread to other institutions.
AHRQ-funded; HS025128.
Citation: Dykes PC, Duckworth M, Cunningham S .
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Jt Comm J Qual Patient Saf 2017 Aug;43(8):403-13. doi: 10.1016/j.jcjq.2017.05.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Evidence-Based Practice, Falls, Hospitals, Injuries and Wounds, Inpatient Care, Patient Safety, Prevention, Risk, Tools & Toolkits
Galambos C, Rantz M, Back J
Older adults' perceptions of and preferences for a fall risk assessment system: exploring stages of acceptance model.
The study aim was to explore the perceptions and preferences of older adults and their family members about a fall risk assessment system. Using a qualitative approach, this study found that there was acceptance of the technology as participants adapted to it. Two themes were present across the five points in time-safety and usefulness. Five stages of acceptance emerged from the data from preinstallation to 2 years postinstallation.
AHRQ-funded; HS018477.
Citation: Galambos C, Rantz M, Back J .
Older adults' perceptions of and preferences for a fall risk assessment system: exploring stages of acceptance model.
Comput Inform Nurs 2017 Jul;35(7):331-37. doi: 10.1097/cin.0000000000000330.
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Keywords: Elderly, Falls, Risk, Patient Safety
Hoffman GJ, Hays RD, Wallace SP
Depressive symptomatology and fall risk among community-dwelling older adults.
The directionality of observed relationship between falls and depressive symptoms (DS) is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship. This study found that the DS-falls relationship was not significant when use of psychiatric medications, which was positively associated with falls, was included in the model.
AHRQ-funded; HS000046.
Citation: Hoffman GJ, Hays RD, Wallace SP .
Depressive symptomatology and fall risk among community-dwelling older adults.
Soc Sci Med 2017 Apr;178:206-13. doi: 10.1016/j.socscimed.2017.02.020.
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Keywords: Depression, Elderly, Falls, Patient Safety, Risk
Hoffman GJ, Hays RD, Wallace SP
Receipt of caregiving and fall risk in US community-dwelling older adults.
The researchers examined whether receipt of low (0-13 weekly hours) and high levels (>/=14 weekly hours) of informal care or any formal care is associated with lower risk of falls and fall-related injuries (FRI) among community-dwelling older adults. They found that among individuals with >/=3 activities of daily living, fall risks were reduced by 21 percent for those receiving high levels of informal care.
AHRQ-funded; HS000046.
Citation: Hoffman GJ, Hays RD, Wallace SP .
Receipt of caregiving and fall risk in US community-dwelling older adults.
Med Care 2017 Apr;55(4):371-78. doi: 10.1097/mlr.0000000000000677.
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Keywords: Caregiving, Elderly, Falls, Risk, Patient Safety
Marier A, Olsho LE, Rhodes W
AHRQ Author: Spector WD
Improving prediction of fall risk among nursing home residents using electronic medical records.
To identify individuals at highest risk for falls, the authors applied a repeated events survival model to analyze The Minimum Data Set ( MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain. They found that incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone.
AHRQ-funded; AHRQ-authored; 290201000031I.
Citation: Marier A, Olsho LE, Rhodes W .
Improving prediction of fall risk among nursing home residents using electronic medical records.
J Am Med Inform Assoc 2016 Mar;23(2):276-82. doi: 10.1093/jamia/ocv061..
Keywords: Falls, Electronic Health Records (EHRs), Risk, Nursing Homes, Prevention
Hignett S, Wolf L, Taylor E
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). : Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management.
AHRQ-funded; HS021824.
Citation: Hignett S, Wolf L, Taylor E .
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
Hum Factors 2015 Nov;57(7):1195-207. doi: 10.1177/0018720815593642.
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Keywords: Patient Safety, Risk, Falls, Hospitals
Steinman BA, Allen SM, Chen J
Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.
The purpose of this study was to examine mediating effects of two indices of physical functioning (mobility and large-muscle functioning) on self-reported vision status, as it relates to falls in older adults. Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status.
AHRQ-funded; HS000011.
Citation: Steinman BA, Allen SM, Chen J .
Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.
J Aging Health 2015 Feb;27(1):158-76. doi: 10.1177/0898264314543473..
Keywords: Elderly, Falls, Eye Disease and Health, Risk
Stone E, Skubic M, Rantz M
Average in-home gait speed: investigation of a new metric for mobility and fall risk assessment of elders.
This study assessed how a new metric, average in-home gait speed (AIGS), measured using a low-cost, continuous, environmentally mounted monitoring system, compares to a set of traditional physical performance instruments used for mobility and fall risk assessment of elderly adults. It found that, using the ability of an instrument to predict how an individual would score on all the instruments as a metric, AIGS performs best, having better predictive ability than the traditional instruments.
AHRQ-funded; HS018477.
Citation: Stone E, Skubic M, Rantz M .
Average in-home gait speed: investigation of a new metric for mobility and fall risk assessment of elders.
Gait Posture 2015 Jan;41(1):57-62. doi: 10.1016/j.gaitpost.2014.08.019..
Keywords: Patient Safety, Falls, Elderly, Risk
Nilsagard Y, Gunn H, Freeman J
Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States.
The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which multiple sclerosis (MS)-associated and demographic factors influence fall rates. It found that persons with MS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.
AHRQ-funded; HS017582.
Citation: Nilsagard Y, Gunn H, Freeman J .
Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States.
Mult Scler 2015 Jan;21(1):92-100. doi: 10.1177/1352458514538884..
Keywords: Falls, Risk, Elderly, Chronic Conditions