Protocol for the home hazards removal program (HARP) study: a pragmatic, randomized clinical trial and implementation study

Susan Stark, Emily Somerville, Marian Keglovits, Jane Conte, Melody Li, Yi Ling Hu, Yan Yan

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network. Methods: We will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study. Discussion: This intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency. Trial registration: identifier: NCT02392013 . Retrospectively registered on March 5, 2015.

Original languageEnglish
Article number90
JournalBMC Geriatrics
Issue number1
StatePublished - Apr 20 2017


  • Falls
  • Home hazards
  • Implementation trial
  • Medically underserved
  • Older adults
  • Randomized controlled trial


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