TY - JOUR
T1 - Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk
AU - Eckstrom, Elizabeth
AU - Parker, Erin M.
AU - Lambert, Gwendolyn H.
AU - Winkler, Gray
AU - Dowler, David
AU - Casey, Colleen M.
N1 - Publisher Copyright:
© 2017 The Author(s). Published by Oxford University Press on behalf of The Gerontological Society of America.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background and Objectives: Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. Design and Methods: We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). Results: Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. Discussion and Implications: We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.
AB - Background and Objectives: Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. Design and Methods: We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). Results: Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. Discussion and Implications: We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.
KW - Clinical practice
KW - Falls
KW - Information technology
KW - Intervention
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U2 - 10.1093/geroni/igx028
DO - 10.1093/geroni/igx028
M3 - Article
AN - SCOPUS:85051382933
SN - 2399-5300
VL - 1
JO - Innovation in Aging
JF - Innovation in Aging
IS - 2
M1 - igx028
ER -