Document Detail

Redesign of an electronic clinical reminder to prevent falls in older adults.
MedLine Citation:
PMID:  23407009     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: : Falls are the leading cause of unintentional injury among US older adults. Guidelines recommend screening patients for fall risk, and providing exercise for patients with gait and balance problems. We redesigned an electronic clinical reminder to improve identification and management of Veterans at high risk for falls, and piloted the reminder in 3 Veterans Health Administration community-based outpatient clinics.
METHODS: : This project had 5 key elements: (1) case finding, (2) efficient collection of condition-specific clinical data, (3) clinical reminders to prompt appropriate care, (4) patient and family education materials, and (5) primary care provider (PCP) decision support/PCP and staff education. We reviewed clinical reminder reports, interviewed nurses and PCPs, directly observed clinic operations, and watched nurses and PCPs use the clinical reminder with a dummy patient record to determine areas in need of improvement.
RESULTS: : Over a 1-year period, 2943 Veterans aged 75 years and older visited the 3 clinics, with 2264 screened for fall risk by the intake nurse, yielding 472 positive screens. PCPs completed gait, balance, and strength evaluations on 231 screen-positive Veterans. Among the 162 Veterans who had a gait, balance, or strength problem on evaluation and were free of advanced dementia or poor prognosis, 39 were offered physical therapy or exercise. PCPs and nurses held divergent opinions about the clinical reminder and the project, with PCPs more negative and nurses more positive.
CONCLUSIONS: : A fall prevention clinical reminder can be incorporated into routine care, but low referral rates to exercise programs suggest that further quality improvement cycles are needed.
Gwendolyn V Spears; Carol P Roth; Isomi M Miake-Lye; Debra Saliba; Paul G Shekelle; David A Ganz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical care     Volume:  51 Suppl     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S37-43     Citation Subset:  IM    
*VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda †The RAND Corporation, Santa Monica ‡Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System §David Geffen School of Medicine, University of California at Los Angeles ∥Borun Center for Gerontological Research, University of California at Los Angeles and Los Angeles Jewish Home, Los Angeles, CA.
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