Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program

Abstract

ImportanceThere is insufficient research on the costs of patient falls in health care systems, a leading source of nonreimbursable adverse events.ObjectiveTo report the costs of inpatient falls and the cost savings associated with implementation of an evidence-based fall prevention program.Design, Setting, and ParticipantsIn this economic evaluation, a matched case-control study used the findings from an interrupted time series analysis that assessed changes in fall rates following implementation of an evidence-based fall prevention program to understand the cost of inpatient falls. An economic analysis was then performed to assess the cost benefits associated with program implementation across 2 US health care systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adults hospitalized in participating units were included in the analysis. Data analysis was performed from October 2021 to November 2022.InterventionsEvidence-based fall prevention program implemented in 33 medical and surgical units in 8 hospitals.Main Outcomes and MeasuresPrimary outcome was cost of inpatient falls. Secondary outcome was the costs and cost savings associated with the evidence-based fall prevention program.ResultsA total of 10 176 patients who had a fall event (injurious or noninjurious) with 29 161 matched controls (no fall event) were included in the case-control study and the economic analysis (51.9% were 65-74 years of age, 67.1% were White, and 53.6% were male). Before the intervention, there were 2503 falls and 900 injuries; after the intervention, there were 2078 falls and 758 injuries. Based on a 19% reduction in falls and 20% reduction in injurious falls from the beginning to the end of the postintervention period, the economic analysis demonstrated that noninjurious and injurious falls were associated with cost increases of $35 365 and $36 776, respectively. The implementation of the evidence-based fall prevention program was associated with $14 600 in net avoided costs per 1000 patient-days.Conclusions and RelevanceThis economic evaluation found that fall-related adverse events represented a clinical and financial burden to health care systems and that the current Medicare policy limits reimbursement. In this study, costs of falls only differed marginally by injury level. Policies that incentivize organizations to implement evidence-based strategies that reduce the incidence of all falls may be effective in reducing both harm and costs.

Evaluation of the cost‐effectiveness of a multicomponent fall prevention program in hospitalized patients

“…Nonetheless, the ICER was considered lower than the cost of patient falls. A recent cost–benefit analysis conducted by Dykes et al (2023) also evaluated the effectiveness of the evidence‐based multifactorial fall prevention program (Fall TIPS—Tailoring Interventions for Patient Safety), in preventing patient falls. The study found that the implementation of Fall TIPS resulted in a net avoided cost of $14.600 per 1000 patient‐days.…”

“…This necessitates the use of cost‐effectiveness analysis as a crucial decision‐making tool (Gupta et al, 2020; Kim & Basu, 2021). While several studies have evaluated the cost‐effectiveness of multicomponent fall prevention programs for adults residing in the community (Alipour et al, 2021; Isaranuwatchai et al, 2017), only a few studies, such as the one conducted by Dykes et al (2023), have assessed the cost‐effectiveness of programs specifically designed for fall prevention in hospital settings.…”

JAMA Health Forum—The Year in Review, 2023

“…Compared with 2022, the total number of manuscript submissions to the journal increased by 25% to 1255 in 2023, and the number of submitted research manuscripts (Original Investigations, Brief Reports, and Research Letters) also rose by 25% to 894 (Table). With the robust growth in manuscript submissions, the journal’s acceptance rate has dropped from 26% to 21% overall and from 20% to 17% for research manuscripts.…”

The Growing Impact and Reach of JAMA Health Forum

“…Articles published in JAMA Health Forum during the first half of 2023 have already been viewed or downloaded nearly 500 000 times through June, including a study with more than 50 000 views . Other widely viewed studies during this time period evaluated the costs and benefits of a program to prevent falls among hospitalized patients, assessed how the length of primary care visits is associated with potentially inappropriate prescribing, and simulated Medicare drug price negotiations under the Inflation Reduction Act . From practical implementation science to timely federal policy questions, JAMA Health Forum articles attract an expansive range of readers, including clinicians, health system leaders, and policymakers.…”