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 社区跌倒不一定是老年人健康老龄化的一部分。然而，跌倒和受伤 社区发病率在65岁以上的社区居民中是一个长期存在的问题 快速增长的人口。跌倒的后遗症包括髋部和其他骨折，头部受伤，害怕跌倒，以及 疗养院住院；创伤和往往代价高昂的结果。有跌倒风险的老年人有 鼓励他们采取行动，减少摔倒的机会。 我们的研究团队正在参与一项正在进行的社区预防跌倒实用试验，战略 减少受伤并培养对长辈的信心(STRIDE)，旨在整合以患者为中心的跌倒 通过使用瀑布护理经理(FCM)和临床决策将预防证据纳入初级保健环境 支持(CDS)，促进共享的预防跌倒决策。Stride由国家研究所提供资金 老龄化和以患者为中心的结果研究所的合作协议编号5U01AG048270。这个 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 医疗保健提供者在决策过程中。大步行动干预的中心是软件 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- 以预防跌倒相关伤害为基础的干预。然后，使用激励性改进跌倒预防计划 由FCM与患者和初级保健团队合作进行面谈。 STRIDE软件的当前版本包括支持基于证据的跌倒所需的算法 包括与患者共同决策的预防护理，但它也有一些限制：1)它是 内置RedCap作为独立数据库，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)它以电子形式构建， 不是动态的，因此造成不必要的文档负担，3)它不支持繁忙的诊所 在提供护理的情况下，必须迅速记录评估和提供CDS的工作流程。 这些限制排除了在受控研究环境之外使用该软件的可能性 需要额外的员工来克服(或“变通”)软件限制。通过这个名为《前进》的项目 跌倒评估和预防以患者为中心的结果研究成果进入多样化的初级保健 实践(ASPIRE)，我们将克服这些障碍。ASPIRE项目的目标是将 医疗研究和质量机构(AHRQ)CDS Connect创作工具，以开发可共享、 基于标准的防摔倒软件，可发布到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，以 支持患者和提供者预防跌倒的决策。

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.