A New Model for Fall Risk Reduction in the American Primary Care Setting

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Alex DeRadke1, Debra Waters2, Cynthia LaCoe-Maniaci3, Melanie Dodd4, Deborah Doerfler5, Mackenzie Savage6, Muskan Katoch7, Andrew Hula8, Savannah Iberra9, Olivia Jastrezemski10, Jenny Davis11

1 University of New Mexico, 2University of New Mexico, 3 Oasis of Albuquerque, 4University of New Mexico, 5 University of New Mexico, 6 University of New Mexico, 7 University of New Mexico, 8 UNM, 9 UNM, 10 UNM, 11 UNM

Clinical Quality

SP - Falls

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Abstract

Introduction:

Falls screening and prevention is underutilized at senior health clinics in the US primarily due to time, staffing constraints, and poor reimbursement. New Mexico’s healthcare system screens adults for falls but rarely offers follow-up for a positive fall screening. This study evaluated the feasibility of a multidisciplinary falls prevention clinic within an older adult primary care clinic.   

Methods:

Patients ≥70 years with a fall in the previous year were recruited for a fall prevention visit with a multidisciplinary team (physical therapist, pharmacist, and physician) and then offered local evidence-based Matter of Balance classes. Participants were followed-up by phone at 1-, 2-, and 3-month intervals. In-depth interviews were conducted with clinic staff. Data analysis consisted of descriptive statistics of billing and exercise adherence and thematic analysis of the interview data.

Results:

The participants were an average age of 82.1 years, n=25, 5 males, 20 females. Billing was at level 4 (CPT 99214) 66.7% of the time in the falls clinic, compared to 64.6% of the time in the standard primary care clinic. Feasibility was assessed using billing data and clinic reviews of internal processes, which demonstrated effective procedures for smooth clinic flow with no burdensome overuse of clinic resources. Self-reported exercise adherence (> 2-3 times a week) was high with 20/23 (87%), 12/18 (89%), and 14/16 (88%) following exercise recommendations on the 1-, 2-, and 3-month follow-up calls, respectively.

Summary:

This multidisciplinary falls prevention clinic generated billing revenue comparable to typical primary care visits and was both financially and practically feasible. This model demonstrates that falls can be addressed in a comprehensive manner that also generates revenue for the clinic by adhering to typical Medicare practices. Larger studies are needed to confirm this model is both feasible and efficacious in other primary care clinics.