Monday, September 23, 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.
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
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.
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.”
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.
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
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.
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.
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
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.”
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
“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.
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
Finding out who's at risk
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.
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
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
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