DASH Project Spotlight: Baltimore Falls Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND)
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Lead agency: Baltimore City Health Department
Partners/collaborators: Baltimore City Department of Housing and Community Development, CRISP (Maryland’s Health Information Exchange), Johns Hopkins University Center for Population Health and Information Technology, University of Maryland, leading community-based and nonprofit organizations
Accidental injuries from falls threaten seniors’ safety and independence. Baltimore is just one community confronting this issue as its population ages. In Baltimore, older adults fall and require hospital care about 5,000 times each year, roughly one-third more than the national average.
Yet even as the personal and economic costs of this epidemic rise, the evidence is clear—most falls are preventable. Through practical lifestyle adjustments, home and physical environment modifications, and community partnerships, the number of falls among seniors can be reduced substantially. Making fall prevention a priority across sectors requires sharing timely, comprehensive data on fall risk factors at the local level so that state and city leaders can take steps to identify and address issues in the built environment as well as offer targeted interventions to prevent falls in the future.
Through Data Across Sectors for Health (DASH), the Baltimore City Health Department is bringing a diverse set of stakeholders and organizations together to examine ways to reduce falls using data-driven approaches. This city-wide collaborative, known as the Baltimore Falls Initiative Engaging Neighborhoods and Data (B’FRIEND), is creating a real-time data surveillance system that will track fall-related emergency department visits and hospitalizations through CRISP, Maryland’s Health Information Exchange. Mike Fried, B’FRIEND Project Director, commented:
“Right now, the focus of our project is helping our network of community partners, who are doing amazing work around falls, become more data-driven and precise in their initiatives…We’re implementing this methodology so that we’ll be able to improve our understanding of falls with better granularity and on a better timescale.”
A large network of community partners will receive regular updates indicating when and where falls are occurring in the city, allowing them to align and focus their efforts. The data will help partners implement evidence-based exercise interventions, home visiting programs, support for medication management, and facility repairs in “hot spot” areas where rates of falls are high.
Core medical data will also be integrated with other health, environmental, and social services data from partner organizations so that analyses can be conducted to inform the development of new and existing initiatives. For example, overlaying falls and housing data will help the Public Housing Authority prioritize their maintenance requests and direct place-based interventions. The results of these analyses will be also used to inform a city-wide communications campaign to prevent falls and social isolation among older adults.
Engaging sectors to work together
The Baltimore City Health Department’s role is to turn information into action, and to convene partners from health care, housing, aging, academic, and social services to make sure that efforts across Baltimore are coordinated around the surveillance data. The team began by meeting with each community partner individually to understand their unique datasets and to learn how each partner could benefit from the project. Fried emphasized the importance of involving a diverse set of community partners early on in the process, noting:
“It’s clear that when you’re being ambitious about public health problems, you can’t do it alone. We’re engaging our partner network aggressively from the beginning to make sure everyone has buy-in. We don’t have the data to share today, but we will in a few months, so ahead of that, we really want everyone to understand it and take ownership of the project.”
The B’FRIEND community partners meet monthly to discuss how they can use the data to streamline their efforts and develop more effective solutions in neighborhoods with high fall rates, like addressing sidewalks in disrepair or offering vision screenings. The project has also given community residents a voice by assembling an advisory group of older adults, nominated by B’FRIEND partners, who provide input to ensure the interventions are reflective of seniors’ needs and concerns.
The B’FRIEND team has been working closely with executive leadership, including the City Solicitor, city lawyers, and the Health Commissioner to obtain input and buy-in on a legal framework for data sharing that maps different legal strategies based on specific applications of the data. In an effort to be transparent at every point in the process, the health department recently invited public comments on a regulation that outlines their authority to access data on fall-related injuries for surveillance and monitoring purposes.
Once the legal agreements are in place, the next step will be developing procedures for managing the data so that ideas can be turned into real-world programs to prevent falls. B’FRIEND has established a strong governance structure that will provide oversight, enabling better decision-making, ensuring compliance with confidentiality laws, and protecting the needs of all the data stakeholders who are involved.
Looking to the future
The ultimate goal of B’FRIEND is to achieve a one-third reduction in fall-related hospitalizations and emergency department visits among older Baltimoreans over three years. Making this vision a reality will require a long-term commitment to data-driven programming across multiple sectors. Fried explained:
“Our hope is that the relationships we establish and the culture we’re fostering outlive the grant itself. The idea that these community partners are coming together to talk about falls initiatives and how we can be more innovative is something we hope to maintain.”
With powerful partnerships in place, the data can have applications that go beyond the original scope of the project. In the future, the Baltimore City Health Department plans to use all the available data to develop a risk score for falls that can be included in medical records to notify primary care doctors about patients’ fall risk, strengthening the connection between population health and primary care.
Moving forward, Fried is also enthusiastic about the opportunity to learn from other similar projects across the country. Through DASH, B’FRIEND is participating in a national learning network called All In: Data for Community Health that aims to accelerate the sharing of lessons and best practices for multi-sector data integration. Fried commented:
“It’s done more to connect individuals doing similar types of work across the country than any other conference or program…We now have a network of people we can call on who are actually doing the same thing. It’s not theoretical, it’s very practical.”
As more efforts across the city join B’FRIEND, the collaboration can serve as a model for using data from diverse sources and sectors to address pressing public health challenges in Baltimore and beyond.
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