Department of Physical Therapy, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA.
Rehabilitation Services, Providence St. Joseph Health, Portland, Oregon, USA.
Gerontologist. 2024 Apr 1;64(4). doi: 10.1093/geront/gnad117.
The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system.
We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults.
STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021.
STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.
使用 RE-AIM（范围、效果、采用、实施和维持）框架来描述在一个大型医疗系统的 34 家门诊康复诊所中，为筛查和评估所有 65 岁以上的老年人跌倒风险，实施 Stopping Elderly Accidents, Deaths, and Injuries (STEADI) 计划（2018-2021 年）的实施情况。
我们描述了实施过程和策略。我们使用电子健康记录 (EHR) 来确定筛查和身体评估的范围、采用和维持情况，以识别老年人的跌倒风险。
STEADI 实施策略包括医疗系统强制规定、EHR 修订、电子邮件说明、教育课程和资源、临床负责人和拥护者以及图表审核。范围：76.4%（50023 人）完成了筛查，44.1%筛查出有跌倒风险。采用：诊所层面的采用情况各不相同，大多数都进行了筛查。专业人员层面的采用情况最高的是物理治疗师（PTs；94.2%开始，80.6%完成），最低的是言语治疗师（SLPs；79.8%开始，55.9%完成）。功能结果测量（FOM）的范围和采用：PTs 对 59.5%有风险的患者完成了 FOM，职业治疗师完成了 11.6%，SLPs 完成了 7.9%。维持：2018 年至 2021 年间，所有措施每年下降 1%-10%。
STEADI 筛查和 FOM 在 34 家门诊康复诊所中得到了全面实施，覆盖了超过 50000 名老年人。筛查的采用率因诊所而异。PTs 的采用率最高。所有采用率随时间下降。未来的研究应该在实施前考虑采用实施科学方法，并征求主要合作伙伴的意见，以确定障碍并制定支持门诊康复中 STEADI 的策略。
