School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
Nottingham CityCare Partnership, Nottingham, UK.
BMJ. 2021 Dec 7;375:e066991. doi: 10.1136/bmj-2021-066991.
To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.
Multicentre, parallel, cluster randomised controlled trial.
Long term care homes in the UK, registered to care for older people or those with dementia.
1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care.
Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care.
Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation.
Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively.
The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency.
ISRCTN34353836.
比较多因素防跌倒计划与常规护理在长期护理院的临床和成本效益。
多中心、平行、群组随机对照试验。
英国的长期护理院，注册为照顾老年人或痴呆症患者。
1657 名同意参与的居民和 84 家护理院。39 家被随机分配到干预组，45 家被随机分配到常规护理组。
《行动指南》（GtACH）：多因素防跌倒计划或常规护理。
91-180 天随机分组后的跌倒率为主要结局测量指标。经济评估使用来自五个领域五个水平版欧洲五维健康量表（EQ-5D-5L）或代理版（EQ-5D-5L-P）和痴呆症生活质量量表（DEMQOL-U）的健康相关生活质量（QALYs）进行测量，这些量表由有能力的居民自行完成，对于所有居民（如果在研究期间能力发生变化），由护理院工作人员代理（DEMQOL-P-U）完成，直到随机分组后 12 个月。次要结局测量指标为随机分组后 1-90、181-270 和 271-360 天的跌倒情况、巴氏指数评分和随机分组后 91、180、270 和 360 天的活动量测量-住宅护理院（PAM-RC）评分。
居民的平均年龄为 85 岁。32%为男性。对 1480 名工作人员中的 1051 名（71%）进行了 GtACH 培训。GtACH 组的 630 名参与者和常规护理组的 712 名参与者提供了主要结局数据。91-180 天内跌倒的未调整发病率比为 0.57（95%置信区间 0.45 至 0.71，P<0.001），GtACH 方案有利（GtACH：每 1000 名居民中有 6 例跌倒/常规护理：每 1000 名居民中有 10 例跌倒）。在所有时间点，Barthel 日常生活活动指数和 PAM-RC 评分在两组之间相似。增量成本为 108 英镑（95%置信区间 -271.06 至 487.58），EQ-5D-5L-P 获得的增量 QALYs 为 0.024（95%置信区间 0.004 至 0.044），DEMQOL-P-U 为 0.005（-0.019 至 0.03）。基于 EQ-5D-5L-P 和 DEMQOL-P-U 的增量成本每 QALY 分别为 4544 英镑和 20889 英镑。
GtACH 方案与跌倒率降低和成本效益相关，同时不影响活动能力或增加依赖。
ISRCTN34353836。
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