Caren Kamberg, Roy T. Young, Takahiro Higashi, Lillian Min, John S. Adams, John T. Chang, David B. Reuben, Rachel Louie, Paul G. Shekelle, Catherine H. MacLean, Neil S. Wenger, Carol P. Roth, Marc Hoffing, David H. Solomon, and Kurt N. Ransohoff
(See editorial comments by C. Seth Landefeld, pp 556–558)OBJECTIVES: To determine whether a practice-based in-tervention can improve care for falls, urinary incontinence,and cognitive impairment.DESIGN: Controlled trial.SETTING: Two community medical groups.PARTICIPANTS: Community-dwelling patients (357 atinterventionsitesand287atcontrolsites)aged75andolderidentified as having difficulty with falls, incontinence, orcognitive impairment.INTERVENTION: Intervention and control practices re-ceived condition case-finding, but only intervention practicesreceived a multicomponent practice-change intervention.MEASUREMENTS: Percentage of quality indicators sat-isfied measured using a 13-month medical record abstrac-tion.RESULTS: Before the intervention, the quality of care wasthe same in intervention and control groups. Screening tri-pled the number of patients identified as needing care forfalls, incontinence, or cognitive impairment. During the in-tervention, overall care for the three conditions was betterin the intervention than the control group (41%, 95% con-fidence interval (CI)535–46% vs 25%, 95% CI520–30%, Po.001). Intervention group patients received bettercare for falls (44% vs 23%, Po.001) and incontinence(37% vs 22%, Po.001) but not for cognitive impairment(44% vs 41%, P5.67) than control group patients. Theintervention was more effective for conditions identified byscreening than for conditions identified through usual care.CONCLUSION: A practice-based intervention integratedinto usual clinical care can improve primary care for fallsand urinary incontinence, although even with the interven-tion, less than half of the recommended care for these con-ditionswasprovided.More-intensiveinterventions,suchasembedding intervention components into an electronicmedical record, will be needed to adequately improve carefor falls and incontinence. J Am Geriatr Soc 57:547–555,2009.Key words: practice-based intervention; geriatric qualityof care; clinical care improvement