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Published on September 18, 2013

UHS and Broome County pilot nationwide fall-prevention program


UHS and Broome County have piloted a program developed by the Centers for Disease Control and Prevention to prevent falls in the elderly, and now are celebrating the success of the program, which will be rolled out across the United States.

UHS, the Broome County Health Department and the Broome County Office for Aging are recipients of a New York State Department of Health injury prevention grant project, funded by the CDC to use evidence-based fall-intervention programs that will reduce the rate of falls in older adults. 

One of the programs is Stopping Elderly Accidents, Deaths and Injuries, also known as STEADI, which encourages primary care providers to conduct regular screenings with patients age 65 and older to determine their risk of falling. 

Under the direction of internal medicine specialist Frank Floyd, MD, and UHS Medical Group nursing administrators Bridget Talbut, RN, and Amy Roma, RN, the team at UHS Primary Care Endwell used preliminary guidelines from the CDC to develop and implement an effective assessment test and data filing system for eligible patients.  

Dr. Floyd reports that in initial pilots of the screening, more than 97 percent of patients over age 65 who needed screening had it completed during their medical appointments.  Based on the success of the pilot site, the screening has now been extended to 13 other UHS Medical Group sites, with most of those also now achieving screening rates of over 90 percent.
         
“We have set the bar for how to roll out the STEADI program and reduce injuries in people over 65," Dr. Floyd said.  "Our work will be used by the CDC to set the national standard.  It has truly been a team effort.  From patient contact to data reporting, it wouldn’t have been possible without the input from all of our team members.”  
        
According to the CDC, one out of three people age 65 and over will fall each year.  Falls are the leading cause of unintentional-injury death and account for 69 percent of nonfatal injuries in the elderly.

“We have an aging population in Broome County, as approximately 17 percent of our residents are 65 and older," noted Broome County Executive Debra Preston.  "It is very important that our older adults have the necessary tools and information for preventing falls. We are fortunate to have community partners like UHS that extend the reach of public health in order to maximize fall prevention and increase the independence of our seniors.”

Claudia Edwards, public health director of the Broome County Health Department, said that the federal and state governments are placing a high emphasis on developing strategies for fall prevention.  The STEADI program will arm healthcare providers with the strategies they need to make a difference.  She said that the state Health Department and the CDC selected Broome County for the STEADI pilot based on the aging demographics of the region. 

UHS became the alpha test site because of its fully established electronic medical record system, which facilitated data collection and reporting to the state Health Department and the CDC.

“Dr. Floyd’s commitment to improving patient care and his passion for the STEADI program made it all a perfect fit,” Ms. Edwards said.  “The CDC and the State of New York are very appreciative to UHS and the commitment of Dr. Floyd and his team.  They championed the program and showed us definite results about how STEADI can improve patient care throughout our region.”
        
Amy Roma, RN, clinical coordinator for Practice Improvement and Education for the UHS Medical Group, played a key part in rolling out the program for the Endwell practice.  She developed a flow sheet on how to conduct assessments and track the data.  After the team worked through a few software challenges, Amy joined forces with staff from the other primary care offices to set up the program at each site.  
        
“Most of the medical practice sites are really excited about participating in STEADI,” she said.  “Providers are embracing it because they realize that it is good for the patients.  We loved watching it evolve.”

Bridget Talbut, RN, nurse manager for the UHS Medical Group, also worked with the primary care sites to implement STEADI.   She said that some staff members had concerns about scheduling problems that could result from requiring them to do additional assessment tests as part of a routine appointment.  
        
“It’s true that the assessment can be time-consuming, but we have proven in several cases that it can identify patients who are at risk and get them the help they need to prevent falls,” she said.  

Most people know an elderly family member or an acquaintance who has suffered a fall with poor consequences.  That’s why everyone can relate to the importance of this program.  

"Locally, STEADI has been very successful and we are proud to be the first healthcare organization in the country to pilot this program," Bridget said.  "Now our work will spread across the country.  It’s pretty amazing.”

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Finding out who's at risk

During a routine appointment, an elderly patient at UHS Primary Care Endwell agreed to have a simple screening to test for the patient’s risk of falling.  When the results showed some mobility concerns, Frank Floyd, MD, ordered further investigation and discovered that the patient was in the very early stages of Parkinson’s disease, although there were no outward signs or symptoms.  As a result, early diagnosis and treatment proved beneficial in helping the patient to manage the disease.
        
The simple screening is part of the STEADI program to identify patients over 65 who may be fall risks. The screening was designed by the federal government's Centers for Disease Control and Prevention and implemented for the first time nationally at UHS Primary Care Endwell last fall.  
        
During the screening, a patient is asked if they have had any previous falls or balance issues.  If the patient answers yes, the screener will conduct a "Timed Up and Go (TUG)" test:  The patient must get up from a chair, walk 10 feet, turn around and return to the chair.   They should be able to complete the exercise in 12 seconds or less.  If they fail the exercise, they are considered at a high fall risk.
        
Patients who score poorly on the screening are given suggestions to improve their situation.  Often that includes recommended changes to the home environment, such as
improved lighting, removal of tripping hazards or installation of stair railings and grab bars.   Screeners also review the patient’s current medications to determine if any of the drugs, by themselves or in combination, could increase fall risk.
        
Patients are typically told to increase their intake of calcium and vitamin D to improve bone and muscle strength.  They may also be advised to use a cane or walker.  In Broome County, patients are given information about the In Balance program offered by UHS Home Care, which teams the patient with a physical therapist who develops a customized approach to help the patient gain strength and balance.  
        
They may also be referred to "Tai Chi: Moving for Better Balance," offered by the YMCA, or the "Stepping On" program presented by Independence Awareness and the Broome County Health Department in partnership with the Office for Aging.

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