Community-based falls do not have to be a part of healthy aging for older adults. However, fall and injury incidence in the community is a persistent problem amongst community dwellers over the age of 65 years, a rapidly growing population. Sequelae from falls include hip and other fractures, head injuries, fear of falling, and nursing home hospitalization; traumatic and often costly outcomes. Older adults who are at risk for falling are encouraged to take actions to reduce their chances of falling. Our research team is participating in an ongoing community-based fall prevention pragmatic trial, Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), which aims to integrate patient centered fall prevention evidence into primary care settings through use of Falls Care Managers (FCM) and clinical decision support (CDS) that promotes shared fall prevention decision-making. STRIDE is funded by the National Institute of Aging and Patient Centered Outcome Research Institute cooperative agreement number 5U01AG048270. The intended goal of CDS is to use clinical knowledge in the context of patient-specific evidence to support healthcare providers in the process of decision-making. At the center of the STRIDE intervention is software used by an FCM and members of the clinical care team to link patient-specific risk factors to tailored evidence- based interventions to prevent fall-related injuries. The fall prevention plan is then refined using motivational interviewing by the FCM in collaboration with the patient and the primary care team. The current version of the STRIDE software includes the algorithms needed to support evidence-based fall prevention care including shared decision-making with patients, but it also has a number of limitations: 1) it is built in REDCap as a standalone database, separate from the electronic health record (EHR) system used to document patient assessments and other patient care activities, 2) it has been built as an electronic form that is not dynamic and therefore creates unnecessary documentation burden, 3) it does not support busy clinic workflows where assessments must be quickly documented and CDS provided in the context of care provision. These limitations preclude use of the software outside of controlled research settings where there are additional staff to overcome (or ?workaround?) the software limitations. Through this project entitled, Advancing Fall ASsessment and PreventIon PatIent-Centered Outcomes REsearch Findings into Diverse Primary Care Practices (ASPIRE), we will overcome these barriers. The goal of the ASPIRE project is to apply the Agency for Healthcare Research & Quality (AHRQ) CDS Connect authoring tool to develop shareable, standards-based fall prevention software that can be posted to the CDS Connect repository. Achieving this goal will address limitations and support wider dissemination of the STRIDE CDS in primary care to support patient and provider fall prevention decision making.

Public Health Relevance

Because of the multi-factorial nature of falls, identifying and prioritizing effective care plans to prevent falls is very challenging. Clinical decision support (CDS) software that could quickly and easily guide clinicians to the most feasible fall prevention strategies for an individual patient and engage patients in fall prevention decision- making are needed to ensure that the evidence-based fall strategies are routinely implemented in clinical practice. The goal of this project is to develop shareable, standards-based fall prevention software that can be widely made available to primary care practices.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration--Cooperative Agreements (U18)
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Healthcare Effectiveness and Outcomes Research (HEOR)
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Teran, Mario
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Brigham and Women's Hospital
United States
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