Lessons Learned From Implementing CDC's STEADI Falls Prevention Algorithm in Primary Care.
Lessons Learned From Implementing CDC's STEADI Falls Prevention Algorithm in Primary Care.
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DOI：
10.1093/geront/gnw074
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Eckstrom E
中科院分区：
文献类型：
--
作者：
Casey CM;Parker EM;Winkler G;Liu X;Lambert GH;Eckstrom E
福尔斯在老年人中导致不成比例的死亡和残疾负担，尽管有循证建议定期筛查跌倒风险，临床试验证明多因素干预对减少福尔斯的有效性。疾病控制和预防中心开发了STEADI（停止老年人事故，死亡和伤害），以帮助初级保健团队筛查跌倒风险并降低老年人跌倒的风险。本文介绍了STEADI在一个大型学术内科诊所利用Kotter框架，用于指导临床实践的变化的工具的实际应用。我们描述了STEADI实施中的关键步骤和决策点，因为它们与Kotter框架的推荐策略有关。战略包括：创造紧迫感，建立指导联盟，形成战略愿景和倡议，招募志愿者，通过消除障碍，产生短期胜利，维持变革和实施变革来实现成功。在试点测试期间对五十六例患者进行了筛查;在实施的前三个月内对360例患者进行了筛查。成功实施的关键是：（a）开发电子健康记录工具和工作流程，以指导临床实践;（B）临床倡导者在实践中积极主动地领导，以识别和应对障碍。在临床环境中实施福尔斯预防需要多个利益相关者的支持和努力。我们强调的挑战，成功和经验教训，为其他临床实践提供指导，在他们的福尔斯预防工作。
Falls lead to a disproportionate burden of death and disability among older adults despite evidence-based recommendations to screen regularly for fall risk and clinical trials demonstrating the effectiveness of multifactorial interventions to reduce falls. The Centers for Disease Control and Prevention developed STEADI (Stopping Elderly Accidents, Deaths, and Injuries) to assist primary care teams to screen for fall risk and reduce risk of falling in older adults. This paper describes a practical application of STEADI in a large academic internal medicine clinic utilizing the Kotter framework, a tool used to guide clinical practice change. We describe key steps and decision points in the implementation of STEADI as they relate to the recommended strategies of the Kotter framework. Strategies include: creating a sense of urgency, building a guiding coalition, forming a strategic vision and initiative, enlisting volunteers, enabling success by removing barriers, generating short-term wins, sustaining change, and instituting change. Fifty-six patients were screened during pilot testing; 360 patients were screened during the first 3 months of implementation. Key to successful implementation was (a) the development of electronic health record (EHR) tools and workflow to guide clinical practice and (b) the proactive leadership of clinical champions within the practice to identify and respond to barriers. Implementing falls prevention in a clinical setting required support and effort across multiple stakeholders. We highlight challenges, successes, and lessons learned that offer guidance for other clinical practices in their falls prevention efforts.
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12.7
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