DNP 740 Week 2 Assessing Population Health Status With Data Example

Six Hundred Twelve Ambulance Calls and a Survey Estimate: Building a Fall-Related Health Status Profile for a Rural County's Older Adults From Five Imperfect Data Sources

[Student Name]

University of Phoenix

DNP/740: Clinical Prevention and Population Health

Week 2 Assignment

[Instructor Name]

[Date]

The county and figures are composites written for a model paper.

Last week, I defined my population as the county's 8,200 community-dwelling adults 65 and older and identified falls as a priority. This paper builds a profile of fall-related health status from the available data, compares it with national trends and assesses what the data can and cannot tell us.

A Pyramid of Falls

Different data sources capture different levels of severity. At the base are all falls, most unreported to anyone; above them are falls with injury; then falls that bring an ambulance or emergency visit; then hospitalizations; and at the top, deaths. Each source sees one layer.

Survey Estimates

Moreland et al. (2020), analyzing national Behavioral Risk Factor Surveillance System data, found that in 2018, 27.5% of adults 65 and older reported falling at least once in the past year and 10.2% reported a fall-related injury, with the percentage reporting falls rising from 2012 to 2016 before declining slightly in 2018. Our state's regional estimate for 2018 was 31%, which, applied to our population, suggests about 2,500 older residents fall each year and about 900 are injured.

Ambulance Data

Emergency medical services recorded 612 fall-related calls for adults 65 and older last year, or 75 per 1,000. Of these, 38% resulted in no transport, often lift assists where the person could not get up alone. Lift assists are an important signal: a person who cannot rise after a fall is at high risk of future harm.

Emergency Department Data

Emergency department records from the regional hospital show 214 fall-related visits by older county residents, or 26 per 1,000. About 30% resulted in admission, most for hip fractures and head injuries.

Two and a half thousand falls, six hundred calls, two hundred visits and a handful of deaths: each number is true, and none alone is the county's problem.

Death Records

Death certificates recorded 11 fall deaths among county residents 65 and older over three years, an average of about 3.7 per year, or 45 per 100,000 older adults. Small numbers make annual rates unstable, so I use a three-year average.

Comparing With National Trends

Nationally, fall death rates among older adults climbed about 3% a year over the decade to 2016 (Burns & Kakara, 2018). Our three-year rate is higher than the most recent national rate I could obtain, but confidence intervals are wide.

Hospitalizations

Of the 214 emergency visits, 64 led to admission, including 29 hip fractures. Hip fractures carry high risk of lasting disability and death within a year, so this layer of the pyramid, though small, represents much of the long-term harm.

Clinic Data

Of 3,100 clinic patients 65 and older, 19% had a documented fall risk screening in the past year, and 8% had a documented fall. Screening is low, so documented falls undercount true falls among clinic patients; when patients are not asked, most falls simply never enter the record, and the clinic's picture of its own patients stays far rosier than the truth.

Subgroup Patterns

Ambulance data show that 41% of fall calls came from the two remote townships, which hold 24% of older residents. Adults 85 and older accounted for 36% of calls but 14% of the older population. Clinic data show lower screening among patients without a visit in the past six months.

Seasonal and Weekly Patterns

Ambulance calls rose in winter months and on weekends, when family members and home health aides are less available. These patterns suggest timing for outreach, such as check-in calls before winter storms and weekend volunteer visits.

Estimating Costs

Florence et al. (2018) estimated that medical costs attributable to fatal and nonfatal falls among older adults were about $50 billion in 2015, with Medicare paying $28.9 billion and Medicaid $8.7 billion for nonfatal falls. Scaling national costs by our share of the older population suggests roughly $1.3 million a year in fall-related medical costs for our county, a rough estimate but useful for making the case to local funders.

Strengths and Limits of Each Source

Survey data capture falls not reported to care but rely on recall and are available only at the regional level. Ambulance data are local and timely but miss falls handled without a call. Emergency data miss residents who use other hospitals. Death data are complete but small. Clinic data reflect only patients who come in and are screened. No source alone describes the problem; together they form a reasonable picture.

Rates Versus Counts

Counts tell the size of the workload; rates allow comparison. The two townships had more calls per 1,000 older residents than the rest of the county, even though their total counts were smaller. Presenting both to the health board avoids the mistake of directing resources only where counts are largest.

Confidence in Small Numbers

With 11 deaths over three years, a single additional death would change the rate by about 10%. For small numbers, I report counts alongside rates and avoid year-to-year comparisons that would mostly reflect chance.

Data Quality Checks

I checked ambulance records for duplicate calls to the same address on the same day and removed 14 duplicates. I also verified that fall calls were coded consistently; some crews had used a general injury code, which I reclassified after reading the narrative.

Data Gaps

We lack local data on fear of falling, which limits activity, and on repeat fallers across sources, since records are not linked. A data-sharing agreement between emergency medical services and the clinic could identify residents with repeated lift assists.

Presenting the Profile

For the health board, I prepared a one-page pyramid graphic showing the estimated falls, injuries, calls, visits and deaths, with township and age breakdowns beside it. Board members said the pyramid made the scale of unreported falls clear for the first time.

What the Profile Suggests for Action

The concentration of calls among residents 85 and older and in remote townships points to where prevention should start. The low screening rate points to a gap in primary care. The high share of lift assists points to a group at high risk who are already in contact with a public service and could be referred.

Health Status Summary

Our older population likely experiences about 2,500 falls a year, about 900 fall injuries, more than 600 ambulance calls and around 200 emergency visits, with rates concentrated among the oldest and those in remote townships. Fall risk screening in primary care is low.

Conclusion

Combining survey, ambulance, emergency, death and clinic data produces a fall-related health status profile for our county's older adults. National surveillance places roughly one older adult in four among those who fall in a given year, and national cost data suggest substantial local costs. Each source has limits, but together they show a large burden concentrated in identifiable subgroups and low screening, which point toward where to act.

References

Burns, E., & Kakara, R. (2018). Deaths from falls among persons aged ≥65 years: United States, 2007-2016. Morbidity and Mortality Weekly Report, 67(18), 509-514. https://doi.org/10.15585/mmwr.mm6718a1

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304

Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years: United States, 2012-2018. Morbidity and Mortality Weekly Report, 69(27), 875-881. https://doi.org/10.15585/mmwr.mm6927a5