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

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.

Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk.

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.