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Rhode Island Fall Injury Prevention Subcommittee

History of the Rhode Island Fall Injury Prevention Subcommittee:
In 2002, the Rhode Island Department of Health (HEALTH) received a three year CDC cooperative agreement to assess and plan for injury prevention in the state.  With this funding, the state initiated Safe Rhode Island (SRI), the state’s violence and injury prevention program.  In 2003, SRI assembled the RI Injury Advisory Council (IAC), a select group of high level stakeholders recruited by the Director of Health, to determine priorities and strategies for preventing injuries and to guide the development of a statewide injury prevention plan.  It was from this advisory group that the Falls Injury Prevention Task Force (FIPTF) was born.  The IAC recommended the creation of task forces to develop recommendations for the three leading causes of injury death and disability to be addressed in the state plan.  These are motor vehicle injury, suicide, and falls among older adults. The FIPTF was formed in 2004 specifically to address the issue of reducing falls in the older adult population of Rhode Island and to develop recommendations for prevention. SRI partnered with the Lieutenant Governor’s Long-term Care Coordinating Council, a community group that was mobilized around the issue of fall injury prevention, to identify membership for the FIPTF.

In 2004, the task forces researched, developed, and wrote recommendations for inclusion in the RI Injury Prevention Plan.  The final plan, published in 2005, positioned SRI to successfully apply for a five-year CDC Core Injury Prevention Grant that same year.  As a condition of funding, the Rhode Island Injury Community Planning Group (ICPG) was established to carry out the recommendations of the plan. 

In 2006, the FIPTF was convened as the Falls Injury Prevention Subcommittee of the ICPG.  This Subcommittee has been functioning as the state coalition for fall prevention since that time. 

Organizations that took the lead in developing the Rhode Island Fall Injury Prevention Subcommittee:  
The Falls Injury Prevention Subcommittee was established after years of research and strategic planning by RI’s Injury Advisory Council.  Prominent members of this group that influenced the development of the FIP subcommittee were former Director of Health Dr. Patricia A. Nolan, who chaired the group, Susan Carcieri, who was first lady at the time, Patrick Lynch, Rhode Island Attorney General, Dr. Pablo Rodriguez, Chairman of the Board, the Rhode Island Foundation, Thomas Izzo, former RI State Senator, and Trudy Cox, Chief Executive, Newport County Preservation Society. Additionally, The Office of the Lieutenant Governor turned over leadership of their Long-term Care Coordinating Council Falls Prevention Subcommittee to SRI.

Once developed, the FIP Subcommittee included representation from a diverse range of organizations committed to fall prevention.  Specifically, the following organizations provided strong leadership: the Department of Elderly Affairs, the University of Rhode Island pharmacy, physical therapy, nursing and exercise science programs, and the RI chapter of the American Association of Retired People (AARP). 

Goals and objectives of the Rhode Island Fall Injury Prevention Subcommittee:   

  • Long Term Goal: Reduce the frequency and associated costs of hospitalizations for fall-related injuries among older adults living in the community.

Objectives:

  1. Infrastructure: Enhance RI infrastructure to implement evidence-based fall prevention programs
  2. Exercise: Increase the percent of seniors adults who exercise on most days of the week
  3. Environmental: Improve the safety of the physical environment in senior adult homes
  4. Chronic Disease: Improve the management of health conditions that place senior adults at increased risk of falls
  5. Medication Management: Increase the percentage of senior adults who have medication reviews to promote medication management
  6. Evaluation: continuously evaluate and monitor process, outcomes, objectives, and program activities.

Outcomes being monitored:

  1. Rate of hospitalization and ED visits for fall-related injuries in Rhode Island
  2. Rate of deaths from fall-related injuries
  3. Rate of hip fractures for females ages 65+
  4. Proportion of adults engaging in regular physical activity.

All funding sources for the Rhode Island Fall Injury Prevention Subcommittee (please be specific):

  1. CDC funded Core Injury Prevention and Control Program uses approximately $50,000 per year for FIP Subcommittee and related activities
  2. In-kind contributions of time and resources from the FIP Subcommittee members; the amount is approximately $25,000 per year

Organizations that are playing a key role in the Rhode Island Fall Injury Prevention Subcommittee:
Rhode Island Department of Health; Injury Prevention Center at Rhode Island Hospital; Coastal Medical Inc.: largest private provider of primary health care in RI: approximately 18,000 of their patients (20%) are over the age of 65.
University of Rhode Island, College of Nursing; Rhode Island College; RI Department of Elderly Affairs; Traumatic Brain Injury Association of Rhode Island; Premier Orthopedics & Work Rehab; Rhode Island Department of Human Services; Providence Tai Chi; Senior center directors; Residential service coordinators; Rhode Island chapter of AARP; Rhode Island Emergency Medical Services; Newport Hospital; Blue Cross Blue Shield of Rhode Island
Eleanor Slater Hospital; Philips Lifeline; Neighborhood Health Plan; Quality Partners of Rhode Island; Alliance for Better Long Term Care; Memorial Hospital; Rhode Island Association of Facilities and Services for the Aging; Rebuilding Together; St. Elizabeth’s Community ; Visiting Nurse Association of New England; Roger Williams Medical Center; Kent County Visiting Nurse Association; Lifespan; Rhode Island Housing; Arthritis Foundation; Education Development Center; Rhode Medical Society; Brown Medical School; Rhode Island Health Care Association; Rhode Island Assisted Living Association; Department of Behavioral Healthcare, Developmental Disabilities and Hospitals

Leadership structure and function of theRhode Island Fall Injury Prevention Subcommittee:
The ICPG Steering Committee (chaired by Michael Mello, MD, MPH, Director of Injury Prevention Center at Rhode Island Hospital) provides oversight for all ICPG subcommittees including the Falls Injury Prevention Subcommittee. The FIP Subcommittee is staffed by Safe Rhode Island, Department of Health.  The chair of the FIP Subcommittee is Rhonda Schwartz, Chief of  Program Development at the Rhode Island  Division of Elderly Affairs.  Per ICPG Bylaws, the Subcommittee must be composed of a minimum of three community stakeholders who volunteer to serve.

The function of the FIP Subcommittee is to facilitate the work of the Steering Committee.  This includes, but is not limited to the priorities identified in the RI Injury Prevention Plan, specifically, decreasing the burden of fall-related injuries/deaths in the state of Rhode Island.

Coalition committees:
Over the years, the FIP Subcommittee has formed temporary ad hoc committees to focus on specific projects.  For example, ad hoc committees have been formed to plan specific C.M.E. opportunities, training events, and evaluation efforts.
           
Regional/county/local coalitions or workgroups you support/provide technical assistance:
The FIP subcommittee has provided technical assistance and trainings on implementation of evidence-based exercise programs to reduce the risk of falls for older adults.  These trainings have been offered to staff of senior centers and senior housing.

2-3 challenges encountered:

1. Position vacancies in staffing at Department of Health, due to hiring freeze and budget crisis
2. Finding a meeting time that works for all partners due to busy schedules
3. Securing the resources needed to implement large scale, evidence-based programs in our state

 

2-3 successes to share:

  1. Coastal Medical partnered with the Rhode Island Injury Community Planning Group (ICPG) Falls Injury Prevention Subcommittee (FIP) December 2010 to jointly sponsor a successful continuing medical education event titled Fall Prevention among Older Adults: The State of the Science. Event participants received 3 AMA PRA category 1 credits© for physicians, 3 contact hours for nurses and certificates of attendance for all allied healthcare professionals. The CME boasted three outstanding speakers who are experts in the field of fall prevention.  During the coffee break, twelve vendor tables were set up, which provided opportunities to learn about additional resources and data in the area of fall prevention, and an expert in Tai Chi offered attendees a demonstration on his craft. Coastal Medical is the largest private provider of primary health care in Rhode Island. It is a physician owned professional, corporation consisting of 17 practices located throughout the state with over 90 practitioners and 400 staff which include Office Managers, Medical Assistants, Medical Secretaries, Nurses, Nurse Care Managers, Pharmacists, Technical Laboratory and Imaging professionals.  The group practice provides care in internal medicine with subspecialties in cardiology, pulmonology, and infectious disease in addition to our 3 pediatric practices.  They also provide ancillary services to patients and the community at large through laboratory and imaging centers. Of the 105,000 patients Coastal Medical provides care to, approximately 18,000 are over the age of 65 (20% of the patient population). Coastal Medical is accredited by the Rhode Island Medical Society to sponsor intrastate continuing medical education for physicians. They have been planning high quality continuing medical education activities for healthcare professionals for the past 14 years. Their CME activities consistently maintain a high standard of excellence. They host 6-7 large CME events per year, with an average of 110 healthcare providers attending each session.   
  2. Office of the Health Insurance Commissioner together with ICPG FIP partners provided training to commercial health plans (Blue Cross/Blue Shield of RI), Department of Health and Human Services (Medicaid) and Neighborhood Health Plan (Medicaid).  This successful symposium, titled Fall Prevention and RI Health Insurers was held in 2007. Safe RI and the Children’s Safety Network Economics and Data Analysis Resource Center provided a cost analysis of RI falls injury hospitalizations.  As a result of this symposium, Blue Cross/Blue Shield of RI developed an initiative to reimburse for environmental screening.
  3. Center for Health Data & Analysis and URI College of Nursing partnered with ICPG Falls Injury Prevention subcommittee to conduct an analysis of RI emergency department (ED.  The subsequent report presents summary information for 2005 – 2009 on hospital ED visits and hospital in-patient discharges in RI for injuries and poisonings with an emphasis on falls.  The brief, titled Injury Visits to Emergency Departments and Hospital Discharges in Rhode Island, 2005-2009: Focus On Falls, can be found at:   http://www.rimed.org/medhealthri/2010-11/2010-11-354.pdf

For additional information on how to join this exciting effort in Rhode Island, contact:

Beatriz Perez, MPH
Manager, Safe Rhode Island
Rhode Island Dept. of Health
3 Capitol Hill
Providence, Rhode Island 02908
401-222-7627
Beatriz.Perez@health.ri.gov
Jennifer Andrade Koziol, MPH
Interim Falls Injury Prevention Project Coordinator
Rhode Island Dept. of Health
3 Capitol Hill
Providence, Rhode Island 02908
401-222-4964
Jennifer.Andradekoziol@health.ri.gov

Website: http://www.health.ri.gov/injury/about/fallsprevention/

Rhode Island Injury Prevention Plan: http://www.sprc.org/stateinformation/pdf/stateplans/plan_ri.pdf                 

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