A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia.

(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