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This retrospective cohort study evaluated the relationship between patient falls, Morse Fall Scale (MFS) items, patient demographics, length of stay and hospital site.
Data were acquired from 72 hospitals in a health system. Logistic regression models were conducted including MFS items, demographics, length of stay, and interaction terms. The final mixed effects logistic regression model included significant patient-level covariates as fixed effects and hospital site as a random effect.
6531 of 978,920 total admissions included a patient fall. Four MFS items (fall history, secondary diagnosis, gait weak/impaired, mental status—overestimates/forgets limitations) and three demographic items (male gender, increased age, longer length of stay) were associated with increased likelihood of falling. Two MFS items (ambulatory aids, intravenous therapy/lock) and Hispanic ethnicity were associated with decreased risk of falling. An interaction effect was present between male gender and mental status. Males who overestimate/forget limitations had 3.16 times higher odds of falling than females oriented to their own ability. The proportion of variance in falls between hospitals was 0.23 and the median odds ratio (MOR) 1.57.
This study uniquely assessed fall risk at the level of the patient and hospital, using data from nearly 1 million admissions at 72 hospitals. Controlling for patient characteristics, results demonstrate variability in fall risk among hospitals. Research informing hospital differences as well as gender and racial/ethnic differences in falls is needed to identify appropriate interventions.
As hospitals increasingly adopt risk-directed fall prevention, assessment tools should be re-evaluated for clinical utility and corresponding prevention practices. The MFS may be enhanced by removing intravenous lock as a risk and screening for additional risks such as medications and medical equipment. Quality improvement efforts must also consider the hospital's environment and processes that may further contribute to fall risk.
Authors adhered to STROBE guidelines for reporting.
No Patient or Public Contribution.
Equitable access to healthcare technology is a major public health issue. For adults with type 2 diabetes (T2D), continuous glucose monitoring (CGM) technology can improve diabetes self-management and clinical outcomes. Even though CGM is now recommended by professional guidelines for all patients with diabetes on insulin therapy, evidence suggests that CGM is underutilised and inequitably prescribed across health systems. As CGM is an emergent technology, it is vital to understand what approaches have been studied to overcome inequities in CGM access for adults with T2D, what aspects of equitable access have yet to be addressed and what are facilitators and barriers to CGM access at the individual, facility and health system levels.
We will use the Joanna Briggs Institute’s revised scoping review framework to conduct our analysis. The protocol is registered with Open Science Framework (https://osf.io/z2exn). We will search for peer-reviewed literature containing empirical evidence for the facilitators and barriers to equitable access to CGM technology for patients with T2D. Findings will be organised according to research objectives and the Framework for Digital Health Equity, and summarised using narrative synthesis of descriptive statistics for quantitative findings, and themes for qualitative findings. This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.
The findings from this review will provide valuable information and support for future research into the equitable implementation and use of CGM for patients with T2D. We will disseminate findings at conferences and publish in a peer-reviewed journal.
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