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

摘要 以社区为基础的福尔斯不一定是老年人健康老龄化的一部分。然而，跌倒和受伤 社区发病率是65岁以上社区居民的一个持续问题， 快速增长的人口。福尔斯的后遗症包括髋部和其他部位骨折、头部受伤、害怕摔倒， 疗养院住院治疗;创伤性和往往昂贵的结果。有跌倒风险的老年人是 鼓励他们采取行动，以减少跌倒的机会。 我们的研究团队正在参与一项正在进行的以社区为基础的跌倒预防实用试验， 减少伤害和建立对老年人的信心（STRIDE），旨在整合以患者为中心的跌倒 通过使用福尔斯护理经理（FCM）和临床决策，将预防证据纳入初级保健环境 支持（CDS），促进共同的跌倒预防决策。STRIDE由国家研究所资助 衰老与以患者为中心的成果研究所合作协议编号5 U 01 AG 048270。的 CDS的预期目标是在患者特定证据的背景下使用临床知识来支持 在决策过程中的医疗服务提供者。STRIDE干预的核心是软件 由FCM和临床护理团队成员使用，将患者特定的风险因素与定制的证据联系起来- 预防跌倒相关伤害的干预措施。跌倒预防计划，然后细化使用动机 由FCM与患者和初级护理团队合作进行访谈。 STRIDE软件的当前版本包括支持循证跌倒所需的算法 预防保健包括与患者共同决策，但它也有一些局限性：1）它是 作为独立数据库内置于REDCap中，独立于电子健康记录（EHR）系统， 记录患者评估和其他患者护理活动，2）它已被构建为电子表格， 不是动态的，因此造成了不必要的文档负担，3）它不支持忙碌的诊所 在工作流程中，必须快速记录评估结果，并在提供护理的背景下提供CDS。 这些限制排除了在受控研究环境之外使用该软件， 额外的工作人员来克服（或“变通办法”）软件的局限性。通过这一名为“促进 以患者为中心的秋季评估和评估结果--多种初级保健的研究结果 实践（ASPIRE），我们将克服这些障碍。ASPIRE项目的目标是应用 医疗保健研究与质量机构（AHRQ）CDS Connect创作工具，用于开发可共享， 基于标准的跌倒预防软件，可以发布到CDS Connect存储库。实现 这一目标将解决限制，并支持在初级保健中更广泛地传播STRIDE CDS， 支持患者和提供者制定跌倒预防决策。

ABSTRACT Community-based falls do not have to be a part of healthy aging for older adults. However, fall and injury incidence in the community is a persistent problem amongst community dwellers over the age of 65 years, a rapidly growing population. Sequelae from falls include hip and other fractures, head injuries, fear of falling, and nursing home hospitalization; traumatic and often costly outcomes. Older adults who are at risk for falling are encouraged to take actions to reduce their chances of falling. Our research team is participating in an ongoing community-based fall prevention pragmatic trial, Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), which aims to integrate patient centered fall prevention evidence into primary care settings through use of Falls Care Managers (FCM) and clinical decision support (CDS) that promotes shared fall prevention decision-making. STRIDE is funded by the National Institute of Aging and Patient Centered Outcome Research Institute cooperative agreement number 5U01AG048270. The intended goal of CDS is to use clinical knowledge in the context of patient-specific evidence to support healthcare providers in the process of decision-making. At the center of the STRIDE intervention is software used by an FCM and members of the clinical care team to link patient-specific risk factors to tailored evidence- based interventions to prevent fall-related injuries. The fall prevention plan is then refined using motivational interviewing by the FCM in collaboration with the patient and the primary care team. The current version of the STRIDE software includes the algorithms needed to support evidence-based fall prevention care including shared decision-making with patients, but it also has a number of limitations: 1) it is built in REDCap as a standalone database, separate from the electronic health record (EHR) system used to document patient assessments and other patient care activities, 2) it has been built as an electronic form that is not dynamic and therefore creates unnecessary documentation burden, 3) it does not support busy clinic workflows where assessments must be quickly documented and CDS provided in the context of care provision. These limitations preclude use of the software outside of controlled research settings where there are additional staff to overcome (or “workaround”) the software limitations. Through this project entitled, Advancing Fall ASsessment and PreventIon PatIent-Centered Outcomes REsearch Findings into Diverse Primary Care Practices (ASPIRE), we will overcome these barriers. The goal of the ASPIRE project is to apply the Agency for Healthcare Research & Quality (AHRQ) CDS Connect authoring tool to develop shareable, standards-based fall prevention software that can be posted to the CDS Connect repository. Achieving this goal will address limitations and support wider dissemination of the STRIDE CDS in primary care to support patient and provider fall prevention decision making.