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