Co-developing implementation strategies to support STEADI (Stopping Elderly Accidents, Deaths, and Injuries) for older adult fall prevention in outpatient physical therapy.

Abstract

Background and objectives: Evidence-based quality improvement (EBQI) is an approach to co-develop implementation strategies with implementation partners. This study describes an EBQI approach for co-developing implementation strategies to support the adoption of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) falls prevention initiative in outpatient physical therapy.

Methods: A multidisciplinary panel (n = 10), representing key partner groups including physical therapists, clinic managers, a referring physician, an older adult with prior physical therapy experience, and a caregiver, collaborated with a research team across 5 outpatient physical therapy clinics within a U.S. health system. Eight virtual EBQI panel sessions conducted over 9 months included meetings, barriers/facilitator ranking, strategy identification/rating, concept mapping, consensus building, and group discussion. Strategies were evaluated on feasibility and importance using Likert-scale surveys and iteratively refined. The main outcome measures were partner-rated rankings of barriers and facilitators to address implementation challenges, rankings of strategy feasibility and importance, and a finalized package of tailored implementation strategies.

Results: Twenty barriers and 20 facilitators were prioritized and ranked by each partner group. Prioritized barriers were matched with prioritized facilitators and/or implementation strategies to address barriers. Of the 78 implementation strategies considered, 39 unique specifications from 22 strategies were identified. Key strategies included clinician education, workflow and electronic health record integration, clinician and older adult-facing materials, clinic champions, and communication templates.

Discussion and implications: EBQI effectively engaged implementation partners in identifying and prioritizing barriers, facilitators, and co-developing tailored, actionable implementation strategies to support STEADI adoption in outpatient physical therapy.