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Request for Information (RFI): Interests and Perspectives of Care Organizations and Patients Regarding an Effectiveness Trial of a Multifactorial Fall Injuries Prevention Strategy for Non-Institutionalized Older Persons

Funding Number: NOT-AG-13-015
Funding Type: NOT
Release Date: June 12, 2013
Expiration Date: January 1, 2020
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Request Information RFI):  Interests Perspectives Care Organizations Patients Regarding Effectiveness Trial a Multifactorial Fall Injuries Prevention Strategy Non-Institutionalized Older Persons Notice Number: NOT-AG-13-015 Key Dates Release Date: June 12, 2013 Response Date: July 9, 2013 Issued National Institute Aging NIA) Purpose Background Fall injuries among older persons constitute substantial public health economic burden.   Risk factors spanning wide range health conditions, functional impairments, environmental conditions, contribute injurious falls. variety multifactorial risk reduction strategies prevent falls been developed.  Clinical trials found substantial efficacy some, lack efficacy others. evidence-based falls prevention protocol, developed jointly the American Geriatrics Society the British Geriatrics Society J Am Geriatr Soc 2012), calls screening older populations identify persons high risk falling, comprehensive assessment high-risk persons' specific risks, tailored, multifactorial treatment ongoing monitoring high-risk persons. Although individual components multifactorial fall risk reduction strategies, are delivered physicians other health care providers, covered third-party payers, lack financial organizational support the communication, planning, coordination among such care providers, is needed implement multifactorial strategies, frequently noted one obstacle their effective implementation. potential barriers implementing such strategies fidelity stability include: burdensome travel between people's homes sites care, gaps fall-specific provider expertise, competing demands clinicians their reluctance implement new practices small segments their patient caseloads, organizations' unwillingness commit managerial resources expertise needed facilitate sustain changes practice. Attention new strategies support provide patient-centered care coordination been increasing a variety types care organizational settings, e.g., Accountable Care Organizations ACOs), Patient-Centered Medical Homes PCMHs) other primary care organizations, HMOs, assisted-living facilities ALFs).  the extent provider organizations overcome obstacles barriers noted above, such settings provide venues a clinical trial a coordinated fall injuries prevention strategy designed both be effective reducing injuries falls if effective) be organizationally financially sustainable diffusible after conclusion the trial. Information Requested National Institute Aging NIA), collaboration the Patient-Centered Outcomes Research Institute PCORI), exploring possible options such trial non-institutionalized older persons.  part this process, NIA seeks information individual stakeholders organizations involved the care well-being older persons. Types information interest differing groups stakeholders include, are limited to, following: 1. Organizations individual members organizations) provide health care housing older persons, e.g., ACOs, HMOs, ALFs, PCMH's, other primary care organizations. a) Availability information its service population is needed design fall-injury prevention trial estimate sample size e.g., fall-injury rates, prevalence risk factors falls fall injuries, currently-used fall-prevention strategies); opportunities obtain information, it not currently available.  b) Organizations' specific methods incentives coordinating primary care the care provided other health professionals e.g., specialists, podiatrists, rehabilitation therapists). c) Opportunities challenges perceived be associated organizations' participation a clinical trial a multifactorial fall injuries prevention program. d) Organizations' willingness capacity participate a multi-site clinical trial fall injuries prevention. e) Clinical, logistical, managerial, financial, other considerations would influence organizations' post-trial decisions adopting sustaining proven effective multifactorial fall injury prevention strategy. 2. Health care professionals would assess treat high-risk participants multifactorial falls prevention programs, e.g., primary care physicians, nurses, physical therapists, occupational therapists. a) they to integrate falls prevention services the routine care their high-risk patients - willingness complete supplemental training the prevention falls fall injuries; willingness adhere the study protocol assessing, treating, monitoring high-risk patients; willingness collaborate communicate the professionals the fall-injuries prevention team; willingness provide documentation adherence a fall injuries prevention protocol; willingness travel perform environmental assessments patients' homes; willingness complete research surveys. b) they to provide falls prevention services clinical trial participants 12-14 hours per week an assisted living facility – willingness complete supplemental training the prevention falls; willingness adhere a study protocol assessing, treating monitoring high-risk patients; willingness collaborate communicate the professionals the fall-injuries prevention team; willingness provide documentation adherence a fall injuries prevention protocol; willingness perform environmental assessments patients' apartments; willingness complete research surveys. 3. Older persons living their homes ALFs have fallen, well their family caregivers representatives relevant patient-advocacy organizations. a) Concerns falling about being injured. b) Interest potential willingness participate a study a comprehensive fall injuries- prevention program. c) Beliefs potential beneficial and/or undesirable effects participating a multifactorial fall injury prevention program included modifications health care, e.g., medications, in living environment, including i) Effects their overall health well-being; ii) Burdens associated time commitment, travel sites care, self-management fall prevention activities, e.g., exercises, of assistive devices, precautions; iii) issues might influence decisions participate a clinical trial fall injuries prevention. d) Beliefs self-management strategies would effective preventing fall injuries. Submitting Response responses must submitted July 9, 2013. Please include Notice number NOT-AG-13-015 the subject line. Response this Request Information RFI) voluntary. Responders free address any all the elements listed above. submitted information be reviewed the NIH staff. Submitted information be considered confidential. RFI for information planning purposes only should be construed a solicitation as obligation the part the U.S. Government the National Institutes Health NIH). NIH does intend make any awards based responses this RFI to otherwise pay the preparation any information submitted for Government's of such information. NIH use information submitted response this RFI its discretion will provide comments any responder's submission. However, responses the RFI be reflected future solicitation(s). information provided be analyzed may appear reports. Respondents advised the Government under obligation acknowledge receipt the information received provide feedback respondents respect any information submitted. proprietary, classified, confidential, sensitive information should included your response. Government reserves right use any non-proprietary technical information any resultant solicitation(s). Inquiries Please direct inquiries to: Sergei V. Romashkan, M.D. National Institute Aging NIA) 7201 Wisconsin Avenue, Suite 525A Bethesda, MD 20892-9205 Fed Ex Packages ZIP 20814) Telephone: 301-435-3047 Fax: 301-480-1066 Email: