The purpose of this study is to develop a consistent approach to prevent falls with injury in nursing home (NH) residents. A centralized Injury Liaison Service (ILS) will be developed and tested in four nursing home facilities (two in the Durham, North Carolina area and two in the Boston, Massachusetts area). The ILS will combine successful elements of a Fracture Liaison Service (FLS) and video telehealth staff education (ECHO) models with the goal of decreasing injurious falls in nursing home residents. The ILS Program has four main components: 1. Automated identification of NH residents at high risk for falls with injury 2. Recommendations by the ILS nurse to manage medications, including deprescribing medications associated with falls and a prescription for osteoporosis medications 3. Video telehealth sessions to educate staff 4. Shared decision making with residents and/or families. The central hypothesis of this study is that the ILS model will reduce injurious falls by changing care delivery in two areas: deprescribing psychoactive and cardiometabolic drugs to reduce falls, and increasing osteoporosis treatment to prevent injury in the setting of a fall. Qualitative interviews will be conducted with nursing home staff to gain a better understanding of effective and non-effective injury prevention strategies. Information from these interviews will be incorporated into the study design. Outcome measures will focus on acceptability, demand, practicality, and feasibility of the program, as well as safety.
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Number of High-risk Residents According to the FRAiL Model
Timeframe: baseline
Number of High-risk Residents With One or More Deprescribing Recommendations
Timeframe: 4 months
Number of Residents Whose Provider Accepted One or More Deprescribing Recommendations
Timeframe: 4 months
Number of Residents Who Accepted One or More Deprescribing Recommendations
Timeframe: 4 months
Number of High-risk Residents With a Recommendation for Osteoporosis Treatment
Timeframe: 4 months
Number of Residents Whose Provider Accepted Osteoporosis Treatment Recommendations
Timeframe: 4 months
Number of Residents Who Accepted Osteoporosis Treatment Recommendations
Timeframe: 4 months
Attrition of Eligible Residents From the NH Facility Due to Transfer, Discharge to Community, or Death
Timeframe: 6 months
Proportion of Staff Members Who Indicated They Were Satisfied or Very Satisfied With the ILS on a Post-intervention Survey
Timeframe: 6 months
Number of Staff Members Who Attended One or More ECHO Sessions
Timeframe: 6 months