Project Details - Ongoing
Grant Number:U18 HS027557
- Funding Mechanism(s):
AHRQ Funded Amount:$993,595
- Principal Investigator(s):
- Project Dates:8/1/2020 to 7/31/2022
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Falls among older adults are common and costly. More than one in four adults age 65 or older fall each year in the United States resulting in traumatic injury, such as hip and other fractures, and head injuries. These falls cause 2.8 million emergency department visits, 800,000 hospital stays, and $49.5 billion in healthcare costs annually. Healthcare providers and systems can help prevent falls by identifying patients at risk of falling and delivering tailored interventions and referrals to community resources. Clinical decision support (CDS) offers a solution to improve routine assessment and identification of adults at risk of falling and the development of evidence-based prevention care plans by primary care practices.
Building on past projects, evidence, and technology, a multi-institution research team will develop shareable, standards-based CDS for fall prevention to support primary care practices in fall risk assessment and prevention care plans. They will use evidence-based decision rules that support care planning with patients from the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) clinical trial; the AHRQ-funded CDS Connect Authoring Tool, a publicly available tool to enable the creation of interoperable CDS; the Patient-Centered CDS Learning Network Analytic Framework for Action; and the experiences of urban and rural clinical settings. This collective project, known as ASPIRE or Advancing Fall Assessment and Prevention Patient-Centered Outcomes Research Findings into Diverse Primary Care Practices, is intended to result in the identification of shareable community-based fall assessment and prevention CDS resources that support interoperable fall prevention CDS logic according to the HL7 Clinical Quality Standard (CQL).
The specific aims of this research are as follows:
- Iteratively develop and test a shareable, interoperable primary care fall prevention patient-centered CDS-–ASPIRE-–by leveraging AHRQ’s CDS Connect Authoring Tool and the HL7 CQL standard.
- Implement and evaluate the ASPIRE CDS and care plan collaboration tool in rural and urban primary care clinics.
The first phase of this research will involve development of patient journey maps to characterize the current state of fall prevention in urban and rural primary care practices. Additionally, the CDS Connect Authoring Tool will be used to translate fall prevention guidelines into computable knowledge using CQL and to develop a web-based care plan collaboration tool that integrates with electronic health record systems.
When the ASPIRE CDS and care plan collaboration tool have been developed, the second phase of the research will evaluate implementation in clinical workflows of urban and rural primary care practices. Research methods will include process flow mapping and analysis, work design and simplification, root cause analysis, and workload estimation. The research team will also conduct semi-structured interviews with patients and focus groups with providers to evaluate acceptability and perceived effectiveness of the ASPIRE CDS. By providing ASPIRE CDS on AHRQ’s CDS Connect Repository, this resource will be publicly available for broad dissemination and use by primary care providers.