Meanwhile, Shorr's research found that up to five falls occur for every 1,000 patient-days in the acute-care setting.
"What's really more the point is that nobody to date has found anything that reduces injury from falls—and that's what costs us money," Brown said. "If a patient falls and breaks a hip that's what we're getting penalized for, but there is no evidence that there is anything that will reduce that. It's hard if you don't have evidence to say 'this is how to do it right.'"
The UF study hopes to identify which components of the regulation work and which do not, which can inform effective fall prevention policies and practices. Co-investigators from Methodist Health Care in Tennessee, Vanderbilt University, Louisiana State University, the University of Tennessee, and the University of Kansas will work with the UF team.
The research will have a three-tiered approach. An analysis will look at practices during the 27 months before the new payment rules went into effect, and during a period of corresponding length after the rule change. Using data from 3,000 nursing units at 1,000 hospitals that feed the National Database of Nursing Quality Indicators, the investigators will look at how many falls and related-injuries occurred, and how many hospital units used of physical restraints.
A more localized study will focus on similar outcomes for four adult hospitals in Memphis, TN. In addition, the team will conduct a case-control study comparing restraint use among people who fell while hospitalized to those who did not fall.
"We'd like to get a better understanding of how hospitals react or are able to react to policies that are set forth by regulatory agencies," said Lorraine Mion, RN, Independence Foundation Professor of Nursing at Vanderbilt University and co-investigator on the study. "Perhaps it will help us understand the ramifications policy has on us in terms of practices, patient outcomes, and cost."