<mods:mods xmlns:mods="http://www.loc.gov/mods/v3" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-7.xsd"><mods:titleInfo><mods:title>The Impact of the Medicare Shared Savings Program on Fall Prevention Services and Falls Among Community-Dwelling Older Adults</mods:title></mods:titleInfo><mods:typeOfResource authority="primo">dissertations</mods:typeOfResource><mods:name type="personal"><mods:namePart>Baird, Courtney Elizabeth</mods:namePart><mods:role><mods:roleTerm type="text">creator</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Gozalo, Pedro</mods:namePart><mods:role><mods:roleTerm type="text">Advisor</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Ryan, Andrew</mods:namePart><mods:role><mods:roleTerm type="text">Reader</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Berry, Sarah</mods:namePart><mods:role><mods:roleTerm type="text">Reader</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Goldberg, Elizabeth</mods:namePart><mods:role><mods:roleTerm type="text">Reader</mods:roleTerm></mods:role></mods:name><mods:name type="corporate"><mods:namePart>Brown University. School of Public Health</mods:namePart><mods:role><mods:roleTerm type="text">sponsor</mods:roleTerm></mods:role></mods:name><mods:originInfo><mods:copyrightDate>2025</mods:copyrightDate></mods:originInfo><mods:physicalDescription><mods:extent>xii, 321 p.</mods:extent><mods:digitalOrigin>born digital</mods:digitalOrigin></mods:physicalDescription><mods:note type="thesis">Thesis (Ph. D.)--Brown University, 2025</mods:note><mods:genre authority="aat">theses</mods:genre><mods:abstract>Introduction: Falls among older adults are common, costly, and preventable, yet uptake of screening and multifactorial interventions is limited. This dissertation (1) develops and validates a Medicare claims-based fall risk prediction model, (2) evaluates whether participation in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) increases delivery of fall-related preventive services, and (3) tests whether MSSP participation reduces fall-related healthcare encounters.
Methods: We assembled a 5% random sample of community-dwelling fee-for-service Medicare beneficiaries aged ≥65 years from 2011–2018. Chapter 1 fit logistic models with repeated LASSO selection to predict next-year falls identified by three fall identification algorithms (ECO, AUR, ECDC), using prior-year demographics, chronic conditions, assistive devices, and healthcare utilization. Chapters 2 and 3 estimated the effects of attribution to the MSSP using the Callaway-Sant’Anna staggered difference-in-differences approach with doubly robust estimation, “not-yet-treated” controls, and beneficiary-clustered standard errors. We assessed the impact of the MSSP on fall risk screening, osteoporosis screening, and fall-related healthcare encounters across the inpatient, outpatient, ED, SNF, HHA, and observation settings.
Results: The cohort included 10,676,150 beneficiaries (mean age 74.7; 56% female). Prediction models achieved strong discrimination (AUCs: ECO 0.776; AUR 0.744; ECDC 0.706) with good calibration. Experiencing a fall in the prior year was the strongest predictor. MSSP attribution increased fall risk screening by 3.42 percentage points (≈96% over the ACO pre-contract mean) with no overall change in osteoporosis screening. MSSP attribution was associated with higher fall-related inpatient (ATT≈0.0047) and SNF (ATT≈0.0016) admissions, with no meaningful association for ER, outpatient, observation, or HHA encounters. Increases were concentrated among females, beneficiaries aged 65-84, and those with the highest baseline fall risk, and were larger for beneficiaries in ACOs with low pre-MSSP screening rates.
Conclusions: Our Medicare claims-based models can reliably stratify fall risk at population scale. Within the MSSP, incentives effectively raised fall risk screening but did not translate into short-term reductions in fall-related healthcare utilization. Aligning incentives with outcome measures (e.g., fall-related hospitalizations) and supporting delivery of multifactorial risk-reduction interventions may be necessary to convert greater fall risk screening into fewer fall-related injuries.</mods:abstract><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01014815"><mods:topic>Medicare</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/00800293"><mods:topic>Aging</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01896327"><mods:topic>Accountable care organizations (Medical care)</mods:topic></mods:subject><mods:subject><mods:topic>health services research</mods:topic></mods:subject><mods:subject><mods:topic>older adults</mods:topic></mods:subject><mods:subject><mods:topic>falls</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/00920083"><mods:topic>Falls (Accidents)--Prevention</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/00920087"><mods:topic>Falls (Accidents) in old age--Prevention</mods:topic></mods:subject><mods:language><mods:languageTerm authority="iso639-2b">English</mods:languageTerm></mods:language><mods:recordInfo><mods:recordContentSource authority="marcorg">RPB</mods:recordContentSource><mods:recordCreationDate encoding="iso8601">20251201</mods:recordCreationDate></mods:recordInfo></mods:mods>