Objectives: Falls among hospitalized elderlies represent a frequent (20-30%) adverse event. About 30% of falls lead to injuries with different types of severity and can provoke long-time disability or death. The prevention of falls in the hospital is possible through the adoption of multimodal strategies. This study aimed at identifying the potential reduction in falls due to the Care Bundle implementation and its cost-effectiveness in real clinical environment Methods: 10 clusters (hospital units) of Bologna USL and University Hospital were randomized in a stepped-wedge design including 4 steps over the years 2015 and 2016. Incidence rates of falls in both the control and intervention periods were calculated considering the patientdays of exposure. The overall crude relative risk (RR) was calculated with its 95% confidence interval. The overall crude incremental cost-effectiveness ratio (ICER) per fall prevented has been calculated. The difference in the rate of patient falls during the intervention period compared with the control period was in the denominator of the ICER. The difference in intervention vs control costs (associated with implementation of the Care Bundle program, length of stay and hospital services provided to patients attributable to falls) was in the nominator. Results: A total of 11844 patients were randomized in this trial (intervention group n=6600, mean(SD) age=80.93(11.62); control group n=5244, mean(SD) age=78.14(12.68)) throughout the overall period. A 13% reduction (RR=0.87 (95% CI: 0.71-1.07)) in falls due to the Care Bundle intervention was observed, though it did not reach statistical significance. The overall ICER was €617.55 for fall prevented. Conclusions: The preliminary analyses showed a positive effect of Care Bundle intervention for preventing falls among aged inpatients at relatively low cost for fall prevented. Deeper statistical analyses to estimate precise cost-effectiveness of the Care Bundle intervention will be conducted shortly.
COST-EFFECTIVENESS EVALUATION OF A CARE BUNDLE INTERVENTION FOR PREVENTING FALLS AMONG ITALIAN AGED INPATIENTS IN A STEPPED-WEDGE CLUSTER RANDOMIZED CONTROLLED TRIAL
Chamitava, L;Di Gennaro, G;Cazzoletti, L;Zanolin, ME
2017-01-01
Abstract
Objectives: Falls among hospitalized elderlies represent a frequent (20-30%) adverse event. About 30% of falls lead to injuries with different types of severity and can provoke long-time disability or death. The prevention of falls in the hospital is possible through the adoption of multimodal strategies. This study aimed at identifying the potential reduction in falls due to the Care Bundle implementation and its cost-effectiveness in real clinical environment Methods: 10 clusters (hospital units) of Bologna USL and University Hospital were randomized in a stepped-wedge design including 4 steps over the years 2015 and 2016. Incidence rates of falls in both the control and intervention periods were calculated considering the patientdays of exposure. The overall crude relative risk (RR) was calculated with its 95% confidence interval. The overall crude incremental cost-effectiveness ratio (ICER) per fall prevented has been calculated. The difference in the rate of patient falls during the intervention period compared with the control period was in the denominator of the ICER. The difference in intervention vs control costs (associated with implementation of the Care Bundle program, length of stay and hospital services provided to patients attributable to falls) was in the nominator. Results: A total of 11844 patients were randomized in this trial (intervention group n=6600, mean(SD) age=80.93(11.62); control group n=5244, mean(SD) age=78.14(12.68)) throughout the overall period. A 13% reduction (RR=0.87 (95% CI: 0.71-1.07)) in falls due to the Care Bundle intervention was observed, though it did not reach statistical significance. The overall ICER was €617.55 for fall prevented. Conclusions: The preliminary analyses showed a positive effect of Care Bundle intervention for preventing falls among aged inpatients at relatively low cost for fall prevented. Deeper statistical analyses to estimate precise cost-effectiveness of the Care Bundle intervention will be conducted shortly.
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