Clinical Decision Support for Fall Prevention in Primary Care
4 affiliations
- 1Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- 2Harvard Medical School, Boston, Massachusetts
- 3The University of Texas Medical Branch at Galveston
- 4Mass General Brigham, Somerville, Massachusetts
Abstract
Importance: Falls are a leading cause of injury among older adults. Although exercise reduces fall risk, implementation in primary care remains limited.
Objective: To assess whether an electronic health record–integrated clinical decision support intervention, Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS), reduces falls among older primary care patients at increased risk.
Design, Setting, and Participants: This matched-pair cluster randomized clinical trial was conducted from June 9, 2023, to May 8, 2025, with 12 to 23 months of follow-up at primary care practices within an integrated health system in the US. Adults aged 65 years or older with a positive 3-item fall-risk screen at a primary care visit were included.
Intervention: eSTEPS decision support embedded in the electronic health record with tailored exercise recommendations, optional physical therapy referral, and patient-facing materials (handouts, website, and app).
Main Outcomes and Measures: The primary outcome was the rate of patients with 1 or more falls identified using electronic health record–derived International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) diagnostic codes. Secondary outcomes were the rate of patients with 1 or more fall-related injuries identified by validated ICD-10 algorithms and mortality.
Results: Among 11 945 participants (mean [SD] age, 77.05 [7.43] years; 8044 females [67.3%]), of whom 5681 (47.6%) were in the intervention group and 6264 (52.4%) were in the control group, at 22 primary care practices, the rate of 1 or more ICD-10 –coded falls (including falls with injuries) per 100 patient-years over the study period was 19.3 (95% CI, 18.6-20.1) in patients from intervention practices vs 21.2 (95% CI, 20.2-22.1) in patients from control practices (rate ratio [RR], 0.91 [95% CI, 0.88-0.95]; P < .001). The rate of ICD-10 –coded fall-related injuries per 100 patient-years was 15.7 (95% CI, 15.0-16.5) from intervention practices vs 16.7 (95% CI, 16.1-17.4) from control practices over the study period (RR for fall injuries per 100 patient-years, 0.94 [95% CI, 0.90-0.97]; P = .001). No differences were observed in mortality. For intervention patients, eSTEPS exercise prescriptions were issued for 1255 patients (22.1%). Overall, 215 clinicians (77.9%) in intervention practices used the clinical decision support to deliver the exercise program at least once over the study period.
Conclusions and Relevance: In this cluster randomized clinical trial of an electronic health record–integrated decision support, falls and fall-related injuries were modestly reduced in older adults in primary care. These results suggest support for scalable, workflow-integrated fall prevention.
Trial Registration: ClinicalTrials.gov Identifier: NCT04993781
Related
- Clinical Decision Support for Fall Prevention in Primary Care : The eSTEPS Cluster Randomized Clinical Trial
- Embedding Adaptable Fall-Prevention Interventions in Primary Care—Small Steps, Broad Reach
- Generative AI-enabled clinical decision support system in primary care: a pragmatic, cluster-randomized trial
- Real-World Effectiveness of AI-Enabled Clinical Decision Support in Primary Care: Systematic Review.
- AI-Based Clinical Decision Support Systems in Primary Care: Systematic Review of Clinical Implementation.
BibTeX
@article{latham2026clinical,
title = {{Clinical Decision Support for Fall Prevention in Primary Care}},
author = {Nancy K. Latham and Erin Hommel and Mackenzie Kiesman and Stuart R. Lipsitz and David W. Bates and Diane L. Carroll and Alexandra C. Frost and Pamela M. Garabedian and Julia V. Loewenthal and Michael Sainlaire and Lipika Samal and Wenyu Song and Matthew Wien and Patricia C. Dykes},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39240},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855390},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical Decision Support for Fall Prevention in Primary Care
AU - Nancy K. Latham
AU - Erin Hommel
AU - Mackenzie Kiesman
AU - Stuart R. Lipsitz
AU - David W. Bates
AU - Diane L. Carroll
AU - Alexandra C. Frost
AU - Pamela M. Garabedian
AU - Julia V. Loewenthal
AU - Michael Sainlaire
AU - Lipika Samal
AU - Wenyu Song
AU - Matthew Wien
AU - Patricia C. Dykes
PY - 2026
DA - 2026/10/16
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.39240
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855390
AB - Importance: Falls are a leading cause of injury among older adults. Although exercise reduces fall risk, implementation in primary care remains limited. Objective: To assess whether an electronic health record–integrated clinical decision support intervention, Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS), reduces falls among older primary care patients at increased risk. Design, Setting, and Participants: This matched-pair cluster randomized clinical trial was conducted from June 9, 2023, to May 8, 2025, with 12 to 23 months of follow-up at primary care practices within an integrated health system in the US. Adults aged 65 years or older with a positive 3-item fall-risk screen at a primary care visit were included. Intervention: eSTEPS decision support embedded in the electronic health record with tailored exercise recommendations, optional physical therapy referral, and patient-facing materials (handouts, website, and app). Main Outcomes and Measures: The primary outcome was the rate of patients with 1 or more falls identified using electronic health record–derived International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) diagnostic codes. Secondary outcomes were the rate of patients with 1 or more fall-related injuries identified by validated ICD-10 algorithms and mortality. Results: Among 11 945 participants (mean [SD] age, 77.05 [7.43] years; 8044 females [67.3%]), of whom 5681 (47.6%) were in the intervention group and 6264 (52.4%) were in the control group, at 22 primary care practices, the rate of 1 or more ICD-10 –coded falls (including falls with injuries) per 100 patient-years over the study period was 19.3 (95% CI, 18.6-20.1) in patients from intervention practices vs 21.2 (95% CI, 20.2-22.1) in patients from control practices (rate ratio [RR], 0.91 [95% CI, 0.88-0.95]; P < .001). The rate of ICD-10 –coded fall-related injuries per 100 patient-years was 15.7 (95% CI, 15.0-16.5) from intervention practices vs 16.7 (95% CI, 16.1-17.4) from control practices over the study period (RR for fall injuries per 100 patient-years, 0.94 [95% CI, 0.90-0.97]; P = .001). No differences were observed in mortality. For intervention patients, eSTEPS exercise prescriptions were issued for 1255 patients (22.1%). Overall, 215 clinicians (77.9%) in intervention practices used the clinical decision support to deliver the exercise program at least once over the study period. Conclusions and Relevance: In this cluster randomized clinical trial of an electronic health record–integrated decision support, falls and fall-related injuries were modestly reduced in older adults in primary care. These results suggest support for scalable, workflow-integrated fall prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT04993781
SN - 2574-3805
ER -