Lessons Learned From Implementing CDC’s STEADI Falls Prevention Algorithm in Primary Care

Abstract

Background Falls lead to a disproportionate burden of death and disability among older adults despite evidence-based recommendations to screen regularly for fall risk and clinical trials demonstrating the effectiveness of multifactorial interventions to reduce falls. The Centers for Disease Control and Prevention developed STEADI (Stopping Elderly Accidents, Deaths, and Injuries) to assist primary care teams to screen for fall risk and reduce risk of falling in older adults. Purpose of the Study This paper describes a practical application of STEADI in a large academic internal medicine clinic utilizing the Kotter framework, a tool used to guide clinical practice change. Design and Methods We describe key steps and decision points in the implementation of STEADI as they relate to the recommended strategies of the Kotter framework. Strategies include: creating a sense of urgency, building a guiding coalition, forming a strategic vision and initiative, enlisting volunteers, enabling success by removing barriers, generating short-term wins, sustaining change, and instituting change. Results Fifty-six patients were screened during pilot testing; 360 patients were screened during the first 3 months of implementation. Key to successful implementation was (a) the development of electronic health record (EHR) tools and workflow to guide clinical practice and (b) the proactive leadership of clinical champions within the practice to identify and respond to barriers. Implications Implementing falls prevention in a clinical setting required support and effort across multiple stakeholders. We highlight challenges, successes, and lessons learned that offer guidance for other clinical practices in their falls prevention efforts.

Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample

“…This finding builds on the apparent face validity of the algorithm14 and is consistent with previous studies demonstrating feasibility of the STEADI algorithm as a screening tool in clinical contexts 16 23 24. For example, Casey and colleagues demonstrated the feasibility of integrating the STEADI risk algorithm into electronic health records of a primary care practice 23. Fall risk screening rates increased over follow-up; however, future fall occurrence was not evaluated 23.…”

“…For example, Casey and colleagues demonstrated the feasibility of integrating the STEADI risk algorithm into electronic health records of a primary care practice 23. Fall risk screening rates increased over follow-up; however, future fall occurrence was not evaluated 23. Although the accurate discrimination of high and low risk by the STEADI measure might be anticipated given the known risk factors contained in the algorithm, empirical evidence of the tool’s predictive validity helps ensure that interventions based on this risk assessment accurately target high risk individuals.…”

STEADI: CDC's approach to make older adult fall prevention part of every primary care practice

“…OHSU successfully implemented STEADI into their clinical practice by: (a) developing a workflow that aligned with (and did not disrupt) their usual clinic flow; (b) integrating the STEADI algorithm within Epic, their electronic health record (EHR) system; (c) pilot testing the workflow and EHR tools before encouraging others clinics to adopt STEADI; and (d) by conducting a 60 minute in-person training sessions to educate health care providers and medical assistants on fall burden, fall risk assessments, and how to use the workflow and EHR tools. (Casey et al, 2016) Within 18 months, the OHSU screened over 870 patients, 45% of its eligible older adult patients (Casey et al, 2016). …”

“…At OHSU providers worked with their health IT staff to establish a health maintenance modifier. A health maintenance modifier is an EHR clinical alert that can be added to a patient’s medical chart to help health care providers identify and implement necessary health screenings (Casey et al, 2016). The STEADI EHR tool also allowed health care providers to assign falls-related medical codes to each patient’s chart based on their risk of falling.…”

An Integrated Approach to Falls Prevention: A Model for Linking Clinical and Community Interventions through the Massachusetts Prevention and Wellness Trust Fund

“…PWTF sites experienced many of the same implementation challenges as other sites nationwide (23), such as securing support from senior leadership and clinical staff; the lack of reimbursement for specific clinical components; no data fields in EMR to capture or assess falls assessments; and lack of workflows and processes for implementing STEADI.…”