Reducing falls in post-acute Medicaid patients enrolled in the Safe Transitions for the Elderly Patient (STEP) Program
Johnson, Valerie W.
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Purpose: The STEP Program is a hybrid transitional care model composed of interdisciplinary team members focused on reducing hospital readmissions, decreasing falls, and improving quality of life. Thus far, no transitional care program has been able to show a significant reduction in falls among post-acute, community dwelling older adults. As the first physical therapy (PT) team to be included in a transitional care program, we sought out to identify potential fallers and reduce falls in this vulnerable population. The purpose of this paper is to evaluate the contribution of PT intervention in the STEP program, specifically as it relates to decreasing falls and falls risk. Methods: We utilized a qualitative, subjective report instrument known as the 4-point Hopkins Falls Grading Scale (HFGS) with good face and content validity to discriminate between the severity and frequency of falls. A systematic, subjective history of falls and comprehensive fall risk assessment scores pre- and post- PT intervention were obtained and analyzed. All data was analyzed using SPSS, and according to the Shapiro-Wilk test, none of the fall data was normally distributed (all yielding p-values of .000). Therefore, we used the Wilcoxon Signed Rank Test to analyze the difference in medians for pre-STEP fall data at 3 months and post-STEP fall data. Results: Preliminary data of a subset of patients reveals promising results for the Hopkin’s Falls Grading Scale with 3 out of 4 grades showing a significant reduction in falls. The Wilcoxon Signed-Rank Test provided the following results. There was a significant decrease in number of Grade 4 Falls (p = .000). There was not enough evidence to support a significant difference in number of Grade 3 Falls (p = .065). There was a significant decrease in number of Grade 2 Falls (p = .000). Finally, there was a significant decrease in number of Grade 1 Falls (p = .004). Grade 3 falls showed no significant difference; however in our distribution, we only had 8 patients that reported Grade 3 falls, compared to 20 patients for Grade 4 falls, 22 patients for Grade 2 falls, and 19 patients for Grade 1 falls. Conclusions: These results confirm the need and importance of collecting pre- and post- PT intervention falls data. At this point in time, 3 out of 4 grades show a significant decrease in falls. The data suggests that transitional physical therapy is effective in showing a reduction in falls in older Medicaid patients recently discharged from the hospital.