Improving quality of fall prevention and management in elderly patients using information technology: The impact of computerized decision support

This thesis explores the role of information technology (IT) for prevention and management of falls in both general practice and hospital settings. Specifically, we address the question of how disease management concepts, process modeling, prognostic models and computerized decision support systems (CDSS) can contribute to a better management of falls shared by general practices, an emergency department and a geriatrics outpatient clinic. The thesis is organized in three parts addressing three research topics. The first topic regards the assessment of the current quality of care, including fall-related care, for the (vulnerable) elderly population. Our study shows that, although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the Assessing Care Of Vulnerable Elders (ACOVE) quality indicators (QIs) is still relatively low. The second topic is the analysis and improvement of the fall management process in an integrated care setting. This part relies on the concepts of disease-management and process modeling. The third topic is the quality of detection and management of falls in community dwelling elderly patients by general practitioners, and how to improve these by using computerized decision support systems. Although our results show that the quality of detection and management of falls in community dwelling elderly patients by general practitioners based on the fall-related ACOVE QIs is relatively low, our intervention showed that our non-intrusive CDSS that provided timely, patient-specific and proactive feedback was effective, at least in the short term, for better management of falls in primary care in terms of adherence to the QIs