Safe in my own home? Investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

We will evaluate the effectiveness of home modifications aimed at giving people the choice to stay safe in their own home rather than move to a costly nursing home or remain in hospital 'bed blocking'.

We will evaluate interventions and compare fall injury rates, for those individuals aged 60 years and over both before and after the intervention, adjusting for age and global trends. Our principal aim of the study is to evaluate impact of home modification interventions on fall-related hospital admissions. Ultimately we will find which home modifications are most effective at reducing falls for different older people.

Design: An event history approach with Poisson mixed models used to achieve an estimate of the intervention effect for the mean number of falls.

Setting: Individual homes throughout Wales, UK. We are able to retrospectively and anonymously link intervention data to specific homes and link through to individual health. The participants will be the anonymous individuals aged 60 years and over who have received a C&R referral or self-referral from 2009-2017.

All persons aged 60 years and over in Wales will be assigned a frailty indes to observe global admission trends, and will use this within an extension of a difference in difference analysis.

Interventions evaluated: Advice visits and physical interventions to improve the home as completed by Care & Repair Cymru, and the impact of combinations/types of fall-related interventions on the health proxy of hospital admissions for falls.

Measurement of outcomes and duration of follow up: Primary outcome data will be fall emergency hospital admissions obtained from the Patient Episode Dataset for Wales (PEDW) dataset for the period 2009 - 2017.

For all individuals matched within SAIL we will extract corresponding individual level data from PEDW. This evaluation will investigate potential delay to move to care home as secondary outcome.

Sample size: We will analyse C&R intervention data and corresponding health data in SAIL. We have a total of 83,162 homes and 86,493 people (2009-2012) and will link an additional four years of data, providing us with sufficient power to detect a meaningful change in hospital admissions to an overall intervention level; and potentially to type of intervention.

We will create event histories at a quarterly resolution containing hospital admissions for each person living in a C&R modified home compared to a group of equally frail people. Data will be analysed