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. 2023 Nov;42(11):2219-2232.
doi: 10.1177/07334648231185757. Epub 2023 Jun 30.

Management of Fall Risk Among Older Adults in Diverse Primary Care Settings

Kristen Shear  1   2 , Hannah Rice  3   4 , Pamela M Garabedian  5 , Ragnhildur Bjarnadottir  1 , Nancy Lathum  3 , Ann L Horgas  6 , Christopher A Harle  7 , Patricia C Dykes  3   4 , Robert Lucero  8
Affiliations

Management of Fall Risk Among Older Adults in Diverse Primary Care Settings

Kristen Shear et al. J Appl Gerontol. 2023 Nov.

Abstract

Objectives: Falls are persistent among community-dwelling older adults despite existing prevention guidelines. We described how urban and rural primary care staff and older adults manage fall risk and factors important to integration of computerized clinical decision support (CCDS).

Methods: Interviews, contextual inquiries, and workflow observations were analyzed using content analysis and synthesized into a journey map. Sociotechnical and PRISM domains were applied to identify workflow factors important to sustainable CCDS integration.

Results: Participants valued fall prevention and described similar approaches. Available resources differed between rural and urban locations. Participants wanted evidence-based guidance integrated into workflows to bridge skills gaps.

Discussion: Sites described similar clinical approaches with differences in resource availability. This implies that a single intervention would need to be flexible to environments with differing resources. Electronic Health Record's inherent ability to provide tailored CCDS is limited. However, CCDS middleware could integrate into different settings and increase evidence use.

Keywords: clinical decision support; evidence-based practice; falls; person centered care; prevention.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Kristen Shear recently completed her PhD with funding from the U.S. Army’s Long-term health and education program. This work was submitted as part of her dissertation and fulfill some requirements for graduation. Request to re-print as part of her dissertation will be requested at a future date. “The views expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense, or any agencies under the U.S. Government”.

Figures

Figure 1.
Figure 1.
Fall Prevention Care Planning Journey Map. Any item marked with * denotes items specific to the urban site. ** denotes items specific to the rural site. All other items were consistent across both locations.
Figure 2.
Figure 2.
Integration of sociotechnical systems theory with PRISM domains. R = recipients I = intervention ISI = implementation sustainability infrastructure. E = external environment RE-AIM = Reach Effectiveness Adoption Implementation and Maintenance.
See this image and copyright information in PMC

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