Year of Publication

2017

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sarah B. Wackerbarth, PhD

Committee Member

Jonathan R. Ballard, MD, MPH, MPhil

Committee Member

Richard C. Ingram, PhD

Abstract

Background: Fall-related morbidity and mortality in the older adult population is a pressing public health problem both nationally and in Kentucky, which has a fall rate above the national average. Implementation of the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention program, offers an opportunity to effectively reduce falls, fall-related injuries and associated costs. The implementation process also serves to foster cooperative interdisciplinary and interdepartmental relationships within health care systems, and bridge public health and clinical practice.

Purpose:The capstone describes and evaluates a pilot of STEADI at the University of Kentucky’s Family and Community Medicine (UKFCM) Clinic. It focuses on pilot development by an interdisciplinary/interdepartmental workgroup and partnership with other key stakeholders, such as the Kentucky Department for Public Health (KDPH). It presents lessons learned, recommendations for improvement and next steps in STEADI implementation. It also reviews the literature on STEADI pilot programs and facilitators and barriers to implementation.

Methods: The five-day pilot was conducted at the UK Family and Community Medicine Clinic. Patients age 65 years and older were screened and evaluated for fall risk using a paper form based on the STEADI algorithm. The pilot was evaluated using the eight-step Kotter model for organizational change.

Results: Sixty-four patients (fifty percent) of patients age 65 and older were screened, of whom forty-four percent screened positive for increased fall risk. Meaningful statistics regarding other components of STEADI were generally not 4 obtainable due to ambiguities in the design of the form. The pilot evaluation demonstrated several steps in the Kotter framework that were particularly successful: creating a sense of urgency; building a guiding coalition; and generating short-term gains. Lessons learned and recommendations included clarification of the assessment and intervention sections of the template before incorporation into the ambulatory electronic health record (AEHR); additional training of providers and staff; and greater attention to workflow.

Implications: STEADI presents an opportunity to bridge public health and clinical practice and if broadly implemented, promises to reduce the Commonwealth’s high rate of older adult fall-related morbidity and mortality, as well as associated costs.

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