Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with mobility limitations but who have trunk stability and upper body strength, what is the comparative risk and benefits of adopting a self-managed bedside commode system versus older assistive toileting technologies?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

See blog for the self-managed bedside commode system: http://beam-gotmindependence.blogspot.com

Existing alternatives: Self-managed: poles and wall grab bars, bedside commode-transfer board combination. Caregiver assistance: lifts, adult diaper. Toleration of fall likelihood: hip pads, mats,

For existing see VA

http://www.cdc.gov/niosh/docs/2006-117/pdfs/2006-117.pdf http://www.visn8.va.gov/PatientSafetyCenter/safePtHandling/Evidencebased_Nelson.ppt#266,6,Common Myths

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

65+, male or female, wheelchair dependent with trunk stability and upper body strength.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Cardiovascular, post-op surgery discharged to home, amputations due to diabetes

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement in patient's ability to manage their own care will improve other ADLs, and decrease caregiver burden, thus increasing the number of people who can age at home, (LaPlante, $44,000/avoided institutionalization) decrease patient falls,

improve worker compensation rates since caregivers taken out of the transfer toileting process avoid home redesign costs

Describe any health-related risks, side effects, or harms that you are concerned about.

Unidentified infection control consequences Patient injury due to defective design Patients encouraged to use the device by caregivers when they are not able to

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus
• Functional limitations and disability
• Pulmonary disease/asthma

AHRQ Priority Populations

• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Patient falls are an issue of great concern to members of the health care community (Cook et al., 1998; Kohn et al., 1999). While patient falls are a problem that extends across the continuum of care, certain patient populations are of special concern (DiBella & Harvey, 1998; National Safety Council, 1999). Among the elderly, falls are the second most common cause of injury deaths and the most common cause of injury visits to the emergency room (Doweiko 2000; Hoskin, 1998). The magnitude of this problem is evident as one-half of nursing home residents and about one third of community dwelling individuals over the age of 65 fall each year (Thapa, et al., 1995). [National Fall Technical Advisory Group Fall Prevention Equipment & Technology Resource Guide, 2001).

Lack of understanding of the importance of any one ADL on other ADLs(National Research Council, IMPROVING THE MEASUREMENT OF LATE-LIFE DISABILITY IN POPULATION SURVEYS: Beyond ADLs and IADLs, Summary of a Workshop, 2009) Potential to improve efficiency of formal caregivers when one patient of 6 now dependent can manage themselves, improve ability of homecare providers to engage in cluster care delivery mode Benefits to users and caregivers, societal savings to providers and payers with avoided institutionalizations

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Personal experience with a mother who aged at home, who had fallen so many times at home that the local fire department came to know her by name as she struggled to maintain her independence. Her fear was to need help with toileting, more than anything else.

Anecdotal, I know, but as I describe this product, I am amazed by the number of people who "just get it." I am suggesting this as a research topic because of its widespread potential to improve the quality of life for the user and the caregiver, and at the same time, provides savings to the health system overall.

I believed that this type of product would have made a difference for her and her family, so after she died, I applied for a patent (2004)for the BeaM-GO(TM) commode (U.S. Patent 7,562,400). The patent just issued (published in Sept, 2009).

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

It is introducing a technology into the world of ADLs, which at the NRC workshop points out, is not well understood.

What does the effect of improving someone's ability to self-toilet have on other ADL's? Will they be more likely to want to dress themselves, stay social, feed themselves? Will it improve caregiver's ability to sustain their caregiving role? Will it encourage the spread of cluster care in homecare? Will nurses and assistive personnel get relief from "on-demand" care need when at least one or two of their patients can manage this process who would otherwise be dependent?

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The product will be more likely to reach the marketplace if an objective, third party has researched its benefits and harms, as well as its cost-effectiveness.

Describe the timeframe in which an answer to your question is needed.

One-to-three months to know if this is considered eligible for consideration.

Implementation ideally starts within a 6-12 month timeframe.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Low-income people who would otherwise be institutionalized will have an opportunity to age at home that they would otherwise not be able to do.

Those without family caregivers available to them will be able to age at home.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The product will be more likely to reach the marketplace if an objective, third party has researched its benefits and harms, as well as its cost-effectiveness.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

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