{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:35:05Z","timestamp":1786480505374,"version":"build-2736575974"},"reference-count":57,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Inpatient falls in hospitals are an acknowledged indicator of quality of care. International comparisons could highlight quality improvement potential and enable cross-national learning. Key to fair cross-national comparison is the availability of a risk adjustment model validated in an international context. This study aimed to 1) ascertain that the variables of the inpatient fall risk adjustment model do not interact with country and thus can be used for risk adjustment, 2) compare the risk of falling in hospitals between Switzerland and Austria after risk adjustment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The data on inpatient falls from Swiss and Austrian acute care hospitals were collected on a single measurement day in 2017, 2018 and 2019 as part of an international multicentre cross-sectional study. Multilevel logistic regression models were used to screen for interaction effects between the patient-related fall risk factors and the countries. The risks of falling in hospital in Switzerland and in Austria were compared after applying the risk-adjustment model.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Data from 176 hospitals and 43,984 patients revealed an inpatient fall rate of 3.4% in Switzerland and 3.9% in Austria. Two of 15 patient-related fall risk variables showed an interaction effect with country: Patients who had fallen in the last 12\u00a0months (<jats:italic>OR<\/jats:italic> 1.49, 95% <jats:italic>CI<\/jats:italic> 1.10\u20132.01, <jats:italic>p<\/jats:italic>\u2009=\u20090.009) or had taken sedatives\/psychotropic medication (<jats:italic>OR<\/jats:italic> 1.40, 95% <jats:italic>CI<\/jats:italic> 1.05\u20131.87, <jats:italic>p<\/jats:italic>\u2009=\u20090.022) had higher odds of falling in Austrian hospitals. Significantly higher odds of falling were observed in Austrian (<jats:italic>OR<\/jats:italic> 1.38, 95% <jats:italic>CI<\/jats:italic> 1.13\u20131.68, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) compared to Swiss hospitals after applying the risk-adjustment model.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Almost all patient-related fall risk factors in the model are suitable for a risk-adjusted cross-country comparison, as they do not interact with the countries. Further model validation with additional countries is warranted, particularly to assess the interaction of risk factors \u201cfall in the last 12\u00a0months\u201d and \u201csedatives\/psychotropic medication intake\u201d with country variable. The study underscores the crucial role of an appropriate risk-adjustment model in ensuring fair international comparisons of inpatient falls, as the risk-adjusted, as opposed to the non-risk-adjusted country comparison, indicated significantly higher odds of falling in Austrian compared to Swiss hospitals.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-024-10839-x","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T10:14:15Z","timestamp":1710324855000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparing risk-adjusted inpatient fall rates internationally: validation of a risk-adjustment model using multicentre cross-sectional data from hospitals in Switzerland and Austria"],"prefix":"10.1186","volume":"24","author":[{"given":"Niklaus S.","family":"Bernet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma H. 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[] for further details). In addition, the Ethics Advisory Board of the Bern University of Applied Sciences approved in 2022 that the anonymized data from the LPZ measurement may be further used without further approval at a cantonal ethics committee (Ref. EAB2022_012). All patients or their legal representatives received written information about the measurement. Written (in Austria) and verbal (in Switzerland) informed consent was obtained from all participants or their legal representatives. Verbal informed consent was authorised in Switzerland by Swiss ethics (Swiss Association of Research Ethics Committees) and the cantonal ethics committees, as described in detail in Bernet et al. []. Patients were informed that they could withdraw their consent at any time without justification and without consequences.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"331"}}