Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS): A Case Study in Implementing Clinical Decision Support Tools to Improve Older Adult Health

Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS) is a research study designed to reduce falls in community-based older adults through implementation of electronic-health record clinical decision support tools. The parent site, Massachusetts General Brigham, is conducting a randomized controlled trial to investigate if adults aged 65+ at high falls risk benefit from computerized alerts and evidence-based, exerciseoriented order sets to reduce falls and falls-related injuries compared to usual care. The University of Texas Medical Branch (UTMB) was selected as a replication site to further test the clinical decision support tools in a pre-post implementation design. This report outlines the strategies used by UTMB to implement the eSTEPS tools within its primary care practices caring for high-risk older adults. Following the RE-AIM framework, we report on the early reach, adoption, and implementation of (or adherence to) the program (reserving effectiveness and maintenance reporting to later project phases). The eSTEPS tools were implemented in April 2023. After excluding a two-month wash-in v period, we provide project outcomes from July 2023 through January 2024. In total, we identified 3472 community-dwelling older adults at high falls risk within UTMB primary care practices. The eSTEPS clinical alert fired for 3210 patients (92.5% of expected). Clinicians used the evidence-based exercise-oriented order sets for 363 patients to initiate referral for formal physical therapy or provide educational materials for a home exercise program. Unfortunately, clinicians dismissed or deferred the clinical alert in 82% of encounters for which it was fired. Preliminary data suggests the eSTEPS clinical decision support tools promote accurate identification of older adults at high falls risk within UTMB and effectively alert primary care clinicians to patients’ need for fallsreducing interventions. We outline several steps necessary to improve project reach, adoption, and adherence which will also enhance the project’s effectiveness to reduce future falls and falls-related injuries. Our lessons learned can be applied across clinical decision support tools intended to facilitate health assessment and promote evidencebased interventions among community-based older adults.

Name thesis:degree_name

Clinical Science (Masters)

Grantor

The University of Texas Medical Branch at Galveston

Year dc:date.issued

2024

Author dc:creator

• Hommel, Erin Leigh 1978-

Advisor dc:contributor.advisor

• Goodwin, James (jsgoodwi@utmb.edu)

Committee member dc:contributor.committeemember

• Lyons, Elizabeth; Pappadis, Monique

Handle dc:identifier.uri

https://hdl.handle.net/2152.3/12689

OAI identifier oai:identifier

oai:utmb-ir.tdl.org:2152.3/12689