Table 1.
Facilitators and Barriers of Clinical Fall Risk Assessments in Primary Care
| RE-AIM | Barriers | Facilitators |
|---|---|---|
|
| ||
| Adoption | Need to modify EMR to include fall screening (KI) Competing demands for IT personnel (KI) Determining case definitions (II, KI) Complexity of IT systems (KI) |
Role of physician project leader as a “champion” (KI) Support of highest level of administration (II, KI) Recognition in working with the CDC (KI) Involvement of staff for buy-in (KI) Ability to alter STEADI to fit workflow (KI) Implementation would not require additional staff (KI) Collaboration with IT to identify appropriate indicators (KI) |
| Implementation | Resistance to administratively imposed change (KI) Top–down implementation (II, KI) Competing demands of other work (II, KI, SU) Complexity of patient needs (II, SU) Documentation burden (II, KI, SU) Time and space required for TUG test (II, KI) Narrative documentation for fall risk plan of care (II) Lack of efficiency using referral form (II) Access to/availability of fall prevention interventions in rural areas (II, KI) Lack of feedback related to follow-through on fall prevention interventions (II, SU) |
Role of physician project leader as a “champion” (KI) Favorable view of nurse leaders who garnered “buy-in” (KI) Commitment to improving health and quality of life (KI, SU) Organizational feedback on falls screening rates (KI) Organizational capacity to do data-driven analyses (KI) Adequate preparation and training (II, KI, SU) EMR screen layout quick and easy to use (KI, SU) Use of referral form for fall-risk interventions (SU) Team approach to implementation (SU) Communication among office staff (KI, SU) Belief that CFRAs reduced falls and health care costs (SU) Incentives for screening (friendly competition) (KI) Recognition and publicity (KI) |
| Maintenance | Staff turnover and training of new staff (II, KI) Need for surveillance monitoring of performance (KI) Limited resources (KI) Documentation considered time-consuming (II, KI) Systematic feedback on referrals to community-based fall-prevention programs (II, KI) Reliance on a physician champion with program success vested in one person (KI) |
Use of unit coordinators in maintaining screening rates (KI) Testimonials from patients about their participation (KI) Organizational feedback on falls screening (KI, SU) National recognition of work (KI) Perceived reduction in fall-related injuries and costs (SU) Meaningful use of health information (KI) |
Notes: II = intercept interviews; KI = key informant interviews; SU = survey; CDC = Centers for Disease Control and Prevention; STEADI = Stopping Elderly Accidents Deaths and Injuries; IT = information technology; EMR = electronic medical record; TUG = Timed Up and Go; CFRAs = clinical fall risk assessments, RE-AIM = Reach, Effectiveness, Adoption, Implementation, and Maintenance.