Clinical Decision Support for Fall Prevention: Defining End-User Needs

Abstract

Background and significance: Falls in community-dwelling older adults are common, and there is a lack of clinical decision support (CDS) to provide health care providers with effective, individualized fall prevention recommendations.

Objectives: The goal of this research is to identify end-user (primary care staff and patients) needs through a human-centered design process for a tool that will generate CDS to protect older adults from falls and injuries.

Methods: Primary care staff (primary care providers, care coordinator nurses, licensed practical nurses, and medical assistants) and community-dwelling patients aged 60 years or older associated with Brigham & Women's Hospital-affiliated primary care clinics and the University of Florida Health Archer Family Health Care primary care clinic were eligible to participate in this study. Through semi-structured and exploratory interviews with participants, our team identified end-user needs through content analysis.

Results: User needs for primary care staff (n = 24) and patients (n = 18) were categorized under the following themes: workload burden; systematic communication; in-person assessment of patient condition; personal support networks; motivational tools; patient understanding of fall risk; individualized resources; and evidence-based safe exercises and expert guidance. While some of these themes are specific to either primary care staff or patients, several address needs expressed by both groups of end-users.

Conclusion: Our findings suggest that there are many care gaps in fall prevention management in primary care and that personalized, actionable, and evidence-based CDS has the potential to address some of these gaps.

Fig. 1

Using content analysis to uncover user needs and generate themes.

Fig. 2

Fall prevention management workflow at BWH and UF study sites. BWH, Brigham & Women's Hospital; UF, University of Florida Health Archer Family Health Care.