General Practice · Internal Medicine · 3 h ago
EHR Decision Support Modestly Reduces Falls in Older Primary Care Patients
In a matched-pair cluster randomized trial across 22 US primary care practices, an EHR-integrated fall-prevention program was evaluated in 11,945 adults aged 65 years or older at increased fall risk. Practices using the program had lower rates of coded falls and fall-related injuries than control practices over 12 to 23 months.
- Cluster trial included 11,945 higher-risk older adults.
- Coded falls were lower with EHR decision support.
- Fall-related injuries also declined modestly.
- Exercise prescriptions reached 22.1% of intervention patients.
Falls are a major source of injury in older adults, but exercise-based prevention is not consistently implemented in primary care. This matched-pair cluster randomized trial tested eSTEPS, an EHR-integrated decision support program, at 22 practices in a US health system. It included 11,945 adults aged 65 years or older who screened positive for fall risk; follow-up ranged from 12 to 23 months. The intervention offered tailored exercise recommendations, optional physical therapy referral, and patient materials.
The rate of patients with at least one ICD-10-coded fall was 19.3 per 100 patient-years in intervention practices and 21.2 in control practices (rate ratio, 0.91; 95% CI, 0.88-0.95). Coded fall-related injuries occurred at rates of 15.7 and 16.7 per 100 patient-years, respectively (rate ratio, 0.94; 95% CI, 0.90-0.97). Mortality did not differ between groups.
The findings suggest that workflow-integrated decision support can modestly reduce recorded falls and injuries in higher-risk older adults. However, exercise prescriptions were issued to 22.1% of intervention patients, and outcomes relied on diagnostic codes, which may not capture every fall. The results support further use and evaluation of scalable primary-care prevention workflows, but do not establish which program components drove the observed differences.
In practice
For adults aged 65 years or older who screen positive for fall risk in primary care, EHR-integrated tailored exercise recommendations, optional physical therapy referral, and patient materials were associated with modestly lower rates of coded falls and fall-related injuries in a cluster randomized trial. The findings support the potential value of embedding prevention support in primary-care workflows, but do not establish which components produced the effect. Exercise prescriptions were issued to only 22.1% of intervention patients, and outcomes depended on diagnostic coding; the results do not by themselves establish a specific exercise regimen or mandate a change in practice.
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JAMA Network Open: Clinical Decision Support for Fall Prevention in Primary Care ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.