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.

Keywords: Clinical decision support; Electronic health record; Falls risk evaluation; Falls screening; Implementation science.

Figure 1

CDC STEADI falls screening and management algorithm. CDC = Centers for Disease Control and Prevention; STEADI = Stopping Elderly Accidents, Deaths, and Injuries.

Figure 2

STEADI workflow for front desk staff, medical assistants (MA), providers. STEADI = Stopping Elderly Accidents, Deaths, and Injuries. ¹Physical therapy/occupational therapy; ²Blood pressure; ³Recommended daily allowance; ⁴Calcium; ⁵Chronic obstructive pulmonary disease; ⁶Diabetes mellitus type 2; ⁷Osteoarthritis; ⁸Mild cognitive impairment; ⁹Multiple sclerosis; ¹⁰Congestive heart failure.