Feasibility of an epidemiological approach to inform population-based fall prevention programs: San Joaquin County, California



Document Type


Conference Title/Conference Publication

Combined Sections Meeting of the American Physical Therapy Association


American Physical Therapy Association


San Antonio, TX

Conference Dates

February 15, 2017-February 18, 2017

Date of Presentation



Purpose/Hypothesis : Novel payment methods for medical care is stimulating a move toward models of multi-professional collaboration and coordination to address health goals. One barrier to adopt novel payment approaches is uncertainty with assessing the health status of service populations. The purpose of this project was to assess the feasibility of using epidemiologic measures to assess the frequency and severity of injuries, using unintentional falls as an example.

Number of Subjects : Unintentional falls data was analyzed that covered the cumulative resident populations of San Joaquin County, California (SJC; n=4,138,531), 8-County San Joaquin Valley Region (8VR; n=19,849,062), and State of California (n=224,982,727) between 2008-2013.

Materials/Methods : The California Department of Public Health’s EpiCenter database was assessed for occurrences of unintentional (accidental) falls between 2008-2013. Frequency, outcome, time of year, and associated patient characteristics were used to calculate stratum-specific incidence, risk ratios, and excess costs. These epidemiological statistics were calculated for SJC, 8VR, and State of California, in order to compare SJC averages with two geographic comparators.

Results : Falls were the 3rd most common cause of unintentional injury mortality in SJC (5.6 per 105), and most common cause of non-fatal hospitalizations (NFH; 262.9 per 105) and non-fatal emergency department visits (EDV; 1,928.2 per 105). Fall-related outcomes generally were less frequent than the State of California average but more frequent than the 8VR. Fall-related mortality was most common in adults aged 45-64 years (3.6 per 105) and adults aged greater than 65 years (35.7 per 105). White individuals accounted for peak race-specific incidence of unintentional fall-related mortality (8.7 per 105), NFH (503.3 per 105), and EDV (2,924.0 per 105). Women accounted for more frequent mortality (4.6 per 105), NFH (314.7 per 105) and EDV (2,059.3 per 105) than men. Peak incidence of fall-related EDV occurred in August (176.7 per 105). Approximately 1,251 more EDV occurred secondary to unintentional falls in SJC compared to the 8VR average during the observation period in adults over the age of 45 years. Reducing EDV related to unintentional falls among adults aged 45 years and over to the 8VR average would save approximately $9.46 million in SJC health expenditures, given facility-weighted mean charges for EDV during the observation period.

Conclusions : Epidemiological methods are a feasible approach to assess relevance and demonstrate outcomes associated with population-based health programs. Important differences between SJC, State of California, and the 8VR in characteristics of unintentional falls were documented.

Clinical Relevance : The methodological approach used in this study indicates physical therapists may use epidemiological methods to support the rationale and track outcomes associated with population-based health programs.

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