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Best Practice in Performance Measurement of Fall Prevention

Training: Toronto Public Health's Step Ahead Program for Health Care

Providers and Caregivers to Older Adults

Toronto Public Health

Susan Plante and Margaret de Wit

Public Health/Primary Health Care Conference June 4-5, 2014

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Foundations for this Work

Mandates

Partnerships

Best Practice Guidelines

• OPHS • Accountability Agreements • City Priorities

• LHINs; PHUs • Research Organizations • Service Providers/Agencies

• RNAO - BPG • International • Performance Measurement

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Step Ahead Program Goals • Improve health outcomes of older people and reduce

burden of falls on the healthcare system in partnership with all healthcare providers serving older adults in Toronto

Objectives • Facilitate adoption of best practice fall prevention

strategies for healthcare agencies • Improve access to fall prevention services for older

adults

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Program Target and Reach

• Targeted to agencies and staff in Toronto serving healthcare needs of elderly, and to other personal caregivers

• 400 agencies currently being reached through

marketing, outreach, other strategies • 60 agencies participated in the training in the last 10

months (timeframe of this study)

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Step Ahead Module 1: Fall Prevention Education

A Step Ahead to Fall Prevention in Older Adults

Training Program for Health and Allied Health Care Providers

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Step Ahead Module 2: Exercises (HSEP – CCAA)

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Use of Best Practice Performance Measures • Funders and other stakeholders now requiring tangible

evidence of program efficacy, the capacity to produce a desired result

• Consequently, a growing emphasis on measures of

quality and impact in addition to activity (e.g., counts of activities or numbers served)

• Performance measurement – focus on outcomes and results about efficiency and effectiveness of a program

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Methods • Various theories used to frame questions about

acquisition, intention and practice of skills/knowledge

Between July, 2013 and April, 2014 • Self-administered questionnaire following

completion of training by 140 participants

• Electronic or telephone survey of 47 consenting participants at 3 months post training

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Key measures

Initial post-training survey: (Activity) How many agencies/people have we

served? (Quality) 1. Did you acquire knowledge/skills? 2. Do you intend to use/share them? 3 months post-training survey: (Impact) Have you used/shared your

knowledge/skills with clients?

Methods (continued)

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Additional measures Initial post-training survey: (Quality) How satisfied were you with the

workshop/training? 3 months post-training survey: (Impact) With how many clients have you used

the exercises?

Methods (continued)

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Survey Completion Rates

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Results - Quality Knowledge Acquisition (initial survey) • 97% reported knowledge increase as a result of the

training, with 68% stating substantial knowledge increase • 98% reported new skills learned

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Results – Quality (continued) Intention (initial survey) • 97% reported intention to share workshop information

with clients • 95% reported intention to use training resources with

clients

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Results – Impact Practice (3 months post training) • 77% with the opportunity (“yes”/”no”) reported knowledge

practice • 41% overall reported “no use” of knowledge or “no

opportunity to use”

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Results – Impact (continued) Practice (3 months post training) • 68% with the opportunity (“yes”/”no”) used HSEP • 55% overall reported “no use” or “no opportunity to use” HSEP

exercises with clients

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Results – Additional Measures Quality

Satisfaction (initial survey) 96% satisfied/very satisfied

Impact Clients served (3 months post training) Over 200 trained by 21 caregivers

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Key Findings and Conclusions

• Survey measures of quality (knowledge/skill, intention) and impact (practice following training) appear useful for collecting meaningful performance data

• Step Ahead provides participants with high quality

practical knowledge and training

• Many participants are also integrating Step Ahead knowledge and training into practice

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Challenges and Limitations Challenges (3 months post training)

• Among those implementing HESP, 21% reported challenges

Limitations • Survey instruments

collected information about self-reported knowledge acquisition, intentions and practice, not actual acquisition, intentions and practice

• Self-selecting nature of

participants studied does not facilitate generalization of results

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Next Steps

• Explore possible challenges with implementation and reasons for non-use, despite initial intentions better identify in-scope agencies and appropriate

target audiences to maximize relevance and uptake of training

assess organizational readiness to support the use of Step Ahead

• Continue with performance measurement and expand

program reach to include all healthcare providers of older adults

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THANK YOU Questions?