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Integrating Fall Prevention into Primary Care in Oregon

Falls are the leading cause of fatal and nonfatal injuries among older adults aged 65 years and older.1 But falls aren’t an inevitable part of aging—and that’s the premise behind the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Initiative from the Centers for Disease Control and Prevention (CDC).

STEADI

The STEADI Initiative includes screening tools, assessment tests, conversation starters, case studies, and evidence-based strategies that health care providers can use to screen for fall risk and reduce the risk of falls among older adults.2

STEADI is based on an algorithm for fall risk assessment and interventions designed to help providers incorporate the American and British Geriatrics Societies’ Clinical Prevention Guidelines for fall prevention. A key component of STEADI is the 3 evidence-based steps that providers can use during a single office visit to help lower the risk of falls in older patients:2

  • Screen patients for fall risk (ask if they: have fallen in the past year, feel unsteady standing or walking, or worry about falling)
  • Review and manage medicines that increase fall risk
  • Recommend vitamin D supplements for improved bone, muscle, and nerve health

Meet Dr. Eckstrom

Dr. Elizabeth Eckstrom, Associate Professor and Director of Geriatrics at Oregon Health & Science University (OHSU), sees patients in the Internal Medicine & Geriatrics Clinic at OHSU, where they’ve been implementing STEADI since 2013.

“Our goal was to make sure everyone over 65 gets screened for falls,” says Eckstrom. “We wanted to integrate the screening into primary care—to really weave it into the fabric of what happens in the clinic."

But that’s not necessarily an easy feat. “The thing about falls is that there are multiple reasons why people fall, so there are multiple interventions that might be needed,” explains Eckstrom. “It can be very complicated—and very time consuming.”

An Emphasis on Clinic Workflow

If you ask Eckstrom how her team has been so successful with STEADI, she immediately stresses the need for establishing a workflow that makes it possible to integrate the steps needed for clinical fall prevention into standard primary care visits.

Eckstrom’s team identified opportunities to do multiple things at the same time—for example, medical assistants started doing medication reviews while patients were lying down waiting to get their blood pressure measured.

They also considered the most convenient locations for the equipment needed to complete the STEADI screening process. And they worked with their IT analysts to make changes to their electronic health record (EHR) tool, Epic®, to better support STEADI. This collaboration also resulted in a clinical EHR program, Preventing Falls in Primary Care Using STEADI, that helps health care professionals incorporate STEADI into any health care setting using the Epic® EHR system.

“That kind of attention to detail has made such a difference. I can’t overemphasize the importance of finding the right workflow,” says Eckstrom.

STEADI Implementation at OHSU by the Numbers3
  • In the first 3 months after implementing STEADI, Eckstrom and her team completed 360 falls screenings.
  • Within 18 months, the clinic had screened over 870 patients—45% of the patients aged 65 years and older who were seen during that time interval.
  • All of the clinic’s 45 internal medicine residents and 30 faculty providers have been trained as STEADI providers.

The Power of Flexibility

Eckstrom also speaks passionately about the need to be flexible—to be willing to look at how things are going and make changes when necessary. “When we were first getting started,” she says, “we checked in with each of the teams weekly to see how it was working.”

That feedback resulted in numerous adaptations to the clinic’s approach for implementing STEADI. “If someone told us that something wasn’t working, we said, ‘Okay, let’s make that change right now.’ Flexibility is key.”

That spirit of willingness to adjust hasn’t faded over time, either. “Just recently, we sat down and talked to staff and wound up completely revamping the program,” says Eckstrom. “We really try to make sure that we’re meeting everybody’s needs.”

Lessons in Teamwork

Eckstrom cites teamwork within her clinic as an important piece of the puzzle, too. “You need a team that works well together,” she says. “And in some ways STEADI really taught us how to do that. We got STEADI, we defined our roles—and it served as a catalyst for establishing good teamwork.”

She also mentions a valuable partnership between her clinic and the Oregon Health Authority (OHA), which had a CDC grant to support STEADI and community fall prevention programs in communities across the state. “That public health partnership gave us community resources that we needed to help our patients.”

For example, OHA worked to improve access to Tai Chi classes—shown to be effective at improving balance and preventing falls—in community centers, gyms, and churches in Oregon.

From Fear to Action

Eckstrom also credits STEADI with helping her clinic’s team address the fear that many older adults have about the implications of falls—and about talking to their providers about them.

“So many patients don’t report falls because they’re afraid of being sent to a nursing home,” says Eckstrom. “STEADI allows us to tell our patients who are afraid of discussing their risk for falls that this is something we do for everyone—fall screening is just a normal part of our practice.” And that can make a huge difference.

“STEADI gives us the opportunity to let patients know that many older adults fall—and that we can do something about it. They leave with concrete steps, like taking a Tai Chi class, changing their glasses, or monitoring their blood pressure. I’ve heard people say, ‘I had no idea there was so much I could do.’ It empowers them to take action because they understand that they can do something about it. They don’t have to fall.”

Big Rewards

It’s hard to talk with Eckstrom without picking up on just how much she loves geriatric medicine—and how much she cares for the patients she treats.

She speaks warmly of a woman who started experiencing falls around age 92. “When I discussed Tai Chi with her, she thought she was too old for it. But we found her a convenient class, and she tried it. Now she has totally stopped falling, and she even recruits her friends to do Tai Chi with her—at age 96!”

STEADI has helped the whole team at OHSU get on board for fall prevention, and Eckstrom is grateful. “We love the program. It’s been fantastic for us.”

1https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm?s_cid=mm6537a2_w

2https://www.cdc.gov/STEADI

3Data provided by the program.

Date Posted:
Organization Name: Oregon Health & Science University / Division of Internal Medicine and Geriatrics
Program Name: 

STEADI (Stopping Elderly Accidents, Deaths, and Injuries)

3181 SW Sam Jackson Park Rd.
Portland, OR 97239
United States
Healthy People 2020 Topic Area(s) addressed: 
Healthy People 2020 Objective(s) addressed: 
Healthy People 2020 overarching goal addressed: 
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Year: 
2017
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