Determinants of Implementing an Adapted Version of STEADI for Fall Prevention of Older Adults Attending Outpatient Rehabilitation in a Large Health Care System.

Abstract

Background and purpose: An adapted version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention initiative was implemented for older adults ≥ 65 years of age attending 34 outpatient physical therapy clinics in a large state-wide health system.

Methods: We explored physical therapists' (PTs) use and perceived determinants of implementation of an adapted version of STEADI using an explanatory mixed-methods approach (n = 50 surveys, 13 interviews). We analyzed survey data using descriptive statistics and mapped interview data to Consolidated Framework for Implementation Research 2.0 constructs using rapid template analysis.

Results and discussion: Participants believed that falls were preventable, used STEADI > 50% of the time, and agreed that STEADI was suitable and implementable. The STEADI components with low reported complexity aligned with high use and are included in the original STEADI (>50%; assessing and intervening in foot problems/footwear, home safety, balance, strength, endurance, gait, activity modifications, and caregiver training). Components with high reported complexity aligned with lower use, and the majority are not included in the original STEADI (<50%; assessing medication, vestibular function, cognition, and pelvic health interventions). Implementation facilitators included compatibility, embedding components of STEADI (eg, questionnaire and functional assessment) in the workflow and electronic health record (EHR), and relational connections. Implementation barriers included perceived lack of capability to conduct specific STEADI components (eg, medication assessment and specific interventions), lack of the EHR workflow of assessment and intervention components, and desire for more clinical decision support in the EHR, implementation support, and ongoing training.

Conclusion: Physical therapists reported higher adoption rates and lower complexity to implement components original to STEADI or common in physical therapy practice compared to the adapted/additional components added by the health system. The study results can be used to develop and adapt strategies to support the implementation and dissemination of STEADI or adapted versions in other outpatient clinics and health systems.