A telemedicine-based risk program to prevent falls among older adults: Study protocol for a randomized quality improvement trial.

BACKGROUND: The Center for Disease Control's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) offers healthcare providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. It's effectiveness has never been evaluated in a randomized trial.

OBJECTIVE: To describe the protocol for the Stopping Elderly Accidents, Deaths, and Injuries (STEADI ) Options Randomized Quality Improvement Trial (RQIT) which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults, 65 years and older, within a primary care setting.

METHODS: STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any one of the Three Key Questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)-led STEADI assessment via telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data were collected on recruitment, STEADI assessments, prevention services recommended, medications, and fall occurrences using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment.

RESULTS: The study enrolled 720 patients (n=307 STEADI arm, n=353 SOC, n=60 discontinued arm). Follow-up data collection was completed in January 2023.

CONCLUSIONS: The STEADI RQIT evaluates the impact of a telemedicine-based STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention's effectiveness and cost-effectiveness.

CLINICALTRIAL: Registration: Clinicaltrials.gov NCT05390736, https://clinicaltrials.gov/ct2/show/NCT05390736.