Developing and testing implementation strategies to support the STEADI for falls risk management in outpatient rehabilitation

摘要/项目摘要 65岁的成年人跌倒是导致发病率、死亡率和高医疗费用的主要原因。临床 指导方针指出，所有医疗保健提供者应通过筛查所有 老年人以及对高危人群的评估和干预。FP使用疾控中心的Steadi(阻止老年人)的努力 (事故、死亡和受伤)被用于初级保健，但障碍限制了吸收和可持续性。物理 治疗师(PTS)是训练有素的合格医疗保健提供者，他们可以在其范围内提供FP 与初级保健相比，实践和拥有更多的一对一时间和频繁的随访，使他们能够 将Steadi纳入门诊康复(Rehab)。然而，研究表明，PTS并没有为有风险的老年人提供FP 戒毒所里的成年人。我们将研究如何最好地支持采用Steadi，并通过 以下目标：(1)确定诊所、提供者和患者层面的障碍和实施的促进者 Steadi在康复中心；(2)制定实施战略，支持在康复中心采用Steadi；(3)试点 测试Steadi在康复中心的实施战略对实施结果的影响(诊所和 提供者级别)，并探索临床结果。我们将创新方法，包括实施 科学(IS)和混合方法方法(目标1和3)和利益攸关方驱动的循证质量 改进(EBQI)过程(目标2)。文森佐博士的背景、职业发展计划和导师 支持使她成为一名优秀的比森奖候选人。她是理疗学副教授 和老年病学，以及拥有公共卫生硕士和博士学位的老年物理治疗委员会认证的临床专家 运动科学。在过去的8年里，她一直是老龄化和FP研究的领导者。她的事业 发展目标是对拟议的研究目标的补充。她将获得培训、指导和 IS、混合方法研究(用于IS)、领导力和老年学研究方面的技能。伊利诺伊大学 阿肯色州医学科学学院(UAMS)是她职业发展和研究的理想环境。 UAMS及其翻译研究所(TRI)通过KL2奖和 将继续提供培训、设备、咨询和指导。UAMS实施中心 由杰弗里·柯伦博士(主要导师)领导的研究将支持她的职业发展并得到指导 在IS方面的研究。UAMS老龄研究所执行主任、医学博士、博士(顾问)珍妮·魏将支持 老年医学研究的进展。共同导师乔纳森·宾，医学博士，公共卫生硕士，詹妮弗·布拉赫，博士，PT，是 老年康复方面的专家和文森佐博士的现有合作者。文森佐博士也将受益于 STRIDE(减少伤害和培养老年人信心的策略)的专业知识研究主任南希 莱瑟姆，博士，PT(顾问)。研究策略、职业发展目标和辅导计划支持 文森佐博士的目标是成为老龄化研究的领先者和IS和FP领域的独立研究员。

Abstract/Project Summary Falls among adults ≥ 65 years are a leading cause of morbidity, mortality, and high healthcare costs. Clinical guidelines indicate that all healthcare providers should conduct annual falls prevention (FP) by screening all older adults and assessing and intervening for those at risk. FP efforts using CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) are used in primary care, but barriers limit uptake and sustainability. Physical therapists (PTs) are trained and qualified healthcare providers who can provide FP within their scope of practice and have more one-on-one time and frequent follow-up compared to primary care, positioning them to incorporate STEADI in outpatient rehab (rehab). Yet, studies indicate PTs are not providing FP to at-risk older adults in rehab. We will examine how to best support uptake of STEADI and address this gap through the following aims: (1) Identify clinic-, provider-, and patient-level barriers to and facilitators of implementing STEADI in rehab; (2) Develop implementation strategies to support the adoption of STEADI in rehab; (3) Pilot test the impact of implementation strategies for STEADI in rehab on implementation outcomes (clinic- and provider-level) and explore clinical outcomes. We will use innovative methods, including implementation science (IS) and mixed-methods approaches (Aims 1 and 3) and a stakeholder-driven evidence-based quality improvement (EBQI) process (Aim 2). Dr. Vincenzo’s background, career development plan, and mentor support make her an excellent Beeson award candidate. She is an Associate Professor of Physical Therapy and Geriatrics, and a board-certified clinical specialist in geriatric physical therapy with an MPH and PhD in exercise science. She has been a leader in aging and FP research for the past 8 years. Her career development objectives complement the proposed research aims. She will obtain training, mentorship, and skills in IS, mixed methods research (used in IS), leadership, and geriatric research. The University of Arkansas for Medical Sciences (UAMS) is an ideal environment for her career development and research. UAMS and its Translational Research Institute (TRI) supported Dr. Vincenzo’s career through a KL2 award and will continue to provide training, equipment, consultation, and mentoring. The UAMS Center for Implementation Research, led by Geoffrey Curran, PhD (primary mentor), will support her career development and mentored research in IS. Jeanne Wei, MD, PhD (advisor), UAMS Institute on Aging executive director, will support development in geriatric research. Co-mentors Jonathan Bean, MD, MPH, and Jennifer Brach, PhD, PT, are experts in geriatric rehab and existing collaborators with Dr. Vincenzo. Dr. Vincenzo will also benefit from the expertise of STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders) study director Nancy Latham, PhD, PT (advisor). The research strategy, career development objectives, and mentoring plan support Dr. Vincenzo’s goals of becoming a leader in aging research and independent investigator in IS and FP.