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Shareable, Interoperable Clinical Decision Support for Older Adults: Advancing Fall Assessment and Prevention Patient-Centered Outcomes Research Findings into Diverse Primary Care Practices (ASPIRE)

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Tools like ASPIRE that integrate fall prevention clinical decision support, and patient resources may better support patient self-care and adoption of evidence-based recommendations.

Project Details -
Completed

One in every four older adults report falls each year, a common occurrence and the leading cause of fatal and nonfatal injuries in the United States. Fall prevention is possible, but older adults who are at the highest risk of falling need to receive appropriate interventions and referrals from their primary care providers (PCPs). Despite recognizing the need, PCPs do not routinely ask older patients about falls and associated risk factors. Additionally, research has shown that even when patients fall, they do not talk about it with their doctors, which only furthers the need to address fall prevention in primary care. Finally, because of the multifactorial nature of falls, identifying and prioritizing effective care plans to prevent falls is challenging.

Computerized clinical decision support (CDS) are needed that could quickly and easily guide PCPs to the most effective fall prevention strategies for an individual patient and engage patients in fall prevention decision making to ensure that evidence-based fall strategies are routinely implemented in clinical practice. However, there has been little or no research on creating shared, interoperable, dynamic decision-making tools for community-based fall risk assessment and prevention.

To address these issues, this research developed a sharable, interoperable, dynamic decision-making tool for community-based fall risk assessment and prevention. The care planning CDS tool—Advancing Fall ASsessment and Prevention PatIent-Centered Outcomes REsearch Findings into Diverse Primary Care Practices (ASPIRE)—supports PCPs in identifying older adults at risk of falling as well as supports decision making by linking fall-prevention evidence to practice and engaging patients in this process.

The specific aims of the research were 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 research team conducted semistructured exploratory interviews, design feedback sessions, and formative and summative usability sessions with primary care providers and community dwelling older adults to understand end-user needs and to inform the iterative development of the CDS prototype.

They then pilot tested ASPIRE at two primary care clinics that used different electronic health records. The study showed that the tool helped to engage patients in fall prevention and that the system had value for PCPs around decision making, in discussions with patients, and as a teaching tool. Qualitative feedback from providers indicated that the use of the tool prompted them to make more physical therapy referrals and reminded them to have discussions about high-risk medications, bisphosphonate (medications for treating osteoporosis) use, and exercise. Users also shared that the tool was visually appealing, simple, and quick to use.

The ASPIRE CDS was developed using informatics standards, and its CDS algorithms are available on the AHRQ CDS Connect website so that others can benefit from the work. Further demonstrations are needed over longer periods of time to show the impact of the ASPIRE CDS on older patients seen in primary care settings.

A Clinical Decision Support Tool for Preventing Falls

Tools like ASPIRE that integrate fall prevention clinical decision support and patient resources may better support patient self-care and adoption of evidence-based recommendations.

Falls can have devastating health consequences for older adults but are not often discussed in primary care

More than one in four older adults report falls each year, a common occurrence and the leading cause of fatal and nonfatal injuries in the United States. Fall prevention is possible, but older adults who are at the highest risk of falling need to receive appropriate interventions and referrals from their primary care providers (PCPs). Despite recognizing the need, PCPs do not routinely ask older patients about falls and associated risk factors. And research has shown that even when patients fall, they don't talk about it with their doctors, which only furthers the need to address fall prevention in primary care.

Identifying and prioritizing effective care plans to prevent falls and related injuries is challenging because falls can be caused by different factors, like the effects of certain medications. Dr. Patricia Dykes, a leading researcher on fall prevention, wanted to develop a clinical decision support (CDS) tool that could quickly and easily guide PCPs to the most effective fall prevention strategies for individual patients and engage them in the fall prevention decision-making process. This is critical to ensuring that evidence-based fall strategies are routinely implemented into clinical practice, and patients are able to actively participate in their healthcare to minimize the risk of having a fall.

ASPIRE is a shareable, interoperable CDS tool for fall prevention

Dr. Dykes and her team at Brigham and Women’s Hospital and collaborators at University of Florida and UCLA developed a shareable, interoperable, dynamic decision-making tool for community-based fall risk assessment and prevention. The care planning CDS tool—Advancing Fall ASsessment and Prevention PatIent-Centered Outcomes REsearch Findings into Diverse Primary Care Practices (ASPIRE)—supports PCPs in identifying older adults at risk of falling, as well as supports decision making by linking fall prevention evidence to practice and engaging patients in this process.

“ASPIRE is based on the data that's already in the electronic health record, for example, if a patient who had ICD codes in the EHR that suggest they had mobility or gait problems. ASPIRE provides decision support for the clinicians and allows them to collaborate with the patient on getting a better assessment of their risk and then informing that tailored or individualized care plan or prevention plan.”- Dr. Patricia Dykes

ASPIRE is valuable and simple to use

The team conducted interviews, design feedback sessions, and usability sessions with PCPs and older adults to understand their end-user needs. They then pilot tested ASPIRE at two primary care clinics that used different electronic health records. The study showed that the tool helped to engage patients in fall prevention and that the system had value for PCPs around decision making, in discussions with patients, and as a teaching tool. Qualitative feedback from providers indicated that the use of the tool prompted them to make more physical therapy referrals and reminded them to have discussions about high-risk medications, bisphosphonate (medications for treating osteoporosis) use, and exercise. Users also shared that the tool was visually appealing, simple, and quick to use.

The ASPIRE tool is the only tailored fall prevention tool designed for use in primary care, and the team hopes it will be further disseminated and used in other care settings. Because Dr. Dykes and her team developed ASPIRE using informatics standards, the ASPIRE CDS algorithms are shareable and now available on the AHRQ CDS Connect website so others can benefit from this work.

Principal Investigator

Dykes, Patricia

Organization

Brigham and Women's Hospital

Research Profile

Funded Amount

$993,595

Research Type

Completed