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Webinar 1: Atlas to Action – How to use the Atlas of Healthcare Variation Falls Domain • Make sure you have your pc and phone connected (see instructions emailed to you) • You will be muted during the webinar to reduce background noise • This webinar will be recorded • Use the public chat or Q&A tab to post a question during the webinar

Webinar 1: From Atlas to Action – How to use the Atlas of Healthcare Variation Falls Domain Dr Shankar Sankaran – Consultant Geriatrician Sandy Blake – Clinical Lead and Director of Nursing Catherine Gerard – Senior Analyst

Outline of webinar • Present on: – Scope of the Programme – Variations analyses and the Falls Atlas – How to use the Atlas data for quality improvement • Opportunity for questions from the audience

Introduction Reducing Harm from Falls: • Aims to reduce the harm that people can suffer if they fall and hurt themselves – especially older people receiving care, whether in hospital, residential care, or in their own home Open for better care Campaign: • 2013 focus: Falls in older people in hospital setting • 2015 focus: An integrated approach to falls in older people across the health sector Atlas supports this work by describing and identifying DHB variation.

Falls Campaign 2015 • From April – September 2015: It is an opportunity to once again raise the profile of the harm people can suffer if they fall and hurt themselves – especially older people receiving care, whether in hospital, residential care, or in their own home. • The 'Stand up to Falls' campaign began on 1 April 2015 with a month- long profile through ‘ April Falls ’

April Falls April falls – An annual focus and Promotion • 2013: 'Falls prevention is everyone's business' and 'Falls Hurt'. • 2014: Regional approaches with a common theme of 'safe care environments'. • 2015: An integrated approach to falls prevention, encouraging DHB regions to work together and link with primary and community care partners.

April Falls 2015 Please complete the National April Falls Quiz Available for download: Workbook – From Atlas to Action

Atlas of healthcare variation • Falls in people aged 50 and over • Atlas looks at whether there is variation by DHB and opportunities for quality improvement: – People with one or more ACC claim for fall- related injury – Admissions following a fall – Hip fracture rates following a fall – Management: time to operation and medications for bone health

Atlases

Unwarranted variation Jack Wennberg: ‘ Variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences.’

Taxonomy of variation 1 • Effective care • Preference-sensitive care • Supply-sensitive care Appleby, Raleigh, Frosini et al. Variations in health care: the good, the bad and the inexplicable. Kings Fund (2011).

Measuring variation Tin openers and dials • Concept from Carter and Klein • Tin openers open up cans of worms – eg bisphosphonate and vitamin D use on discharge • Dials measure things

This is not a league table • High is not necessarily better • Low may not be worse • The middle might not be right Bisphosphonate on discharge following hip fracture

Method • Rate/1,000 people who had one or more: – ACC claim for a fall-related injury – Hospital admission – Average bed days – Hip fracture – Time to surgery – Medications for bone health on discharge – Sub-analyses by year (2011-2013), age, ethnicity and gender

• View atlas and explain how to view and different ways of presenting the data

Key findings Age ACC claims, rate Hospital admissions, Hip fracture, rate per band per 1000 (count) rate per 1000 (count) 1,000 (count) 50 – 64 107 (92,301) 6 (4781) 0.2 (113) 65 – 74 116 (44,140) 11 (4293) 1.3 (402) 75 – 84 163 (33,142) 33 (6933) 5.8 (1125) 85+ 258 (20,103) 93 (7699) 21.4 (1712)

Key findings Of people aged 85+: • 25% had an ACC claim in 2013 for a fall-related injury • 9% were admitted to hospital • Average LOS was 13.6 days Hip fracture: • Nearly ½ were in those aged 85+

Key findings – variation Average bed days (falls) • National mean 11.7 days, range 7.1- 15 days) Bone health in 6 months following hip fracture: • 27% dispensed bisphosphonate – Varied from 8% – 48% • 55% dispensed vitamin D – Varied 26% – 72%

This data raises questions • Why do some DHBs have consistently higher rates? • What impact might orthogeriatric services have on this data? • What about Fracture Liaison Services?

Suggested actions In your DHB area: know your data – what’s your plan? • Topic 10: 10 priorities in an integrated approach to falls in older people • Falls Workbook: From Atlas to Action

10 topics: primary and secondary prevention of falls Topic Focus 1 Falls in older people - the impacts 2 Which older person is at risk of falling? Ask, assess, act 3 Falls risk assessment and care planning - what really matters? 4 Safe environment and safe care: essential in preventing falls 5 After a fall: what should happen? 6 Why hip fracture prevention and care matters 7 Vitamin D and falls: what you need to know 8 Medicines: balancing benefits and falls risks 9 Improving balance and strength to prevent falls 10 An integrated approach to falls in older people: what is your part?

Other resources Ask, Assess, Act Pocketcard The 10 Topics cover core issues in falls prevention to update you on current evidence and best practice and can count Focus on Falls as learning activities for A quarterly professional publication for development everyone interested hours. in understanding and preventing falls in older people. For more information and resources visit: http://www.hqsc.govt.nz/our-programmes/reducing-harm-from-falls

Other resources • Hip fracture care: – Australian and New Zealand Hip Fracture Registry, resources and guidelines: www.anzhfr.org – Topic 6: Why hip fracture prevention and care matters

Resources for consumers

Thank you Questions? Use public chat or the Q&A tab