Purpose: The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes.
Methods: Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage.
Results: Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over &dollar1 million with a per-patient enrolled savings of &dollar19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of &dollar4.95 million or &dollar15,618 per enrolled patient.
Conclusion: Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.

Plain Language Summary: This study explored the feasibility and impact of implementing an evidence-based fall prevention model into emergency medical services for older adults. The outcomes resulted in an efficient and effective manner to screen older adults for falls during emergency response services and connect high-risk older adults with in-home follow-up care from community paramedics. In addition, fall prevention services were provided for vulnerable adults following a recent discharge from hospital care. These initiatives to address fall prevention resulted in a majority of older adults receiving preventive fall risk screening during emergency response calls, significant changes in quality of life measures for adults with multiple comorbidities and fall risk, and significant potential cost savings in reduced healthcare services.

Keywords: fall prevention, emergency providers, Mobile Integrated Healthcare, paramedics, age-friendly


中文翻译：

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将跌倒预防策略纳入 EMS 服务，以减少老年人的跌倒和相关医疗费用

目的：本研究的目的是详细说明通过紧急医疗服务 (EMS) 实施跌倒预防举措及相关结果。
方法： MedStar 移动医疗保健的护理人员利用阻止老年人事故、死亡和受伤 (STEADI) 跌倒预防模型，通过 9-1-1 紧急响应、高利用率组 (HUG) 和 30 天再入院进行筛查和直接干预回避 (HRA) 计划。 9-1-1 电话的结果测量了接受跌倒筛查并确定风险因素的老年人数量。 HUG 和 HRA 计划通过 EuroQol-5D、转诊服务利用率、跌倒、紧急医疗保健利用率和再入院数据来衡量生活质量的变化。分析包括与减少医疗保健使用相关的成本。
结果：紧急护理人员对 50.5%（n=45,090）65 岁及以上成年人进行了跌倒风险筛查，其中 59.3% 有跌倒风险，其中 48.1% 正在服用已知会增加跌倒风险的药物。通过 HUG 和 HRA 计划提供的服务以及额外所需的转诊服务，导致与跌倒相关的 9-1-1 呼叫减少了 37.2%，与生活质量相关的整体健康状况提高了 29.5%。对 HUG 计划的分析表明，每位患者登记可节省 19,053 美元，可节省超过 100 万美元。 HRA 计划显示出 16.4% 的再入院率，而地区平均水平为 30.2%，并且每位入组患者节省了 495 万美元或 15,618 美元的成本。
结论：将 STEADI 模型实施到 EMS 服务中，为解决老年人跌倒预防问题提供了一种有效且节省成本的模式，为老年人提供了有意义且有影响力的改善，并可以作为其他 EMS 项目的模型。

通俗易懂的语言摘要：本研究探讨了在老年人紧急医疗服务中实施循证跌倒预防模式的可行性和影响。结果产生了一种高效且有效的方式，可以在紧急响应服务期间筛查老年人是否跌倒，并将高危老年人与社区护理人员的家庭后续护理联系起来。此外，还为最近出院后的弱势成年人提供跌倒预防服务。这些旨在预防跌倒的举措使得大多数老年人在紧急响应电话期间接受了预防性跌倒风险筛查，患有多种合并症和跌倒风险的成年人的生活质量指标发生了重大变化，并且减少了医疗服务，从而大大节省了潜在的成本。

关键词：跌倒预防、急救人员、移动综合医疗、护理人员、老年友好型