Evaluating the effectiveness of a telemedicine-based STEADI implementation in primary care on fall outcomes: the STEADI options randomized controlled trial.

BACKGROUND AND

OBJECTIVES

Falls are a leading cause of injury and death among older adults (65 years and above). The Centers for Disease Control and Prevention's Stopping Elderly Accident, Deaths, and Injuries (STEADI) initiative aims to reduce falls by screening to find at-risk individuals, evaluation, and then addressing modifiable risk factors. This study evaluated the effectiveness of implementing a STEADI-based multi-component fall prevention approach via telemedicine in primary care.

RESEARCH DESIGN AND

METHODS

A randomized controlled quality improvement trial (STEADI Options) was conducted during the COVID-19 pandemic (July 2020-December 2021). Primary care professionals (PCPs) were randomized to either standard-of-care (SOC) or intervention. The intervention included a fall risk assessment by a research nurse, who shared STEADI-based recommendations with PCPs. Recommended interventions were administered at the discretion of PCPs. Outcomes included self-reported falls (primary), medically treated falls, fall-related service utilization (physical therapy, occupational therapy, eye care, podiatry), and medication changes, assessed over one year. Analyses followed an intent-to-treat approach.

RESULTS

Among 660 participants (353 SOC; 307 intervention), the cohort was predominantly female (67.7%), aged 65-79 years (73.6%), and non-Hispanic White (56.1%). Intervention participants had higher average Stay Independent Screener (SIS) scores (6.3 vs. 5.2; p < 0.001). Overall, 5.5% reported a fall in the past 12 months. No significant differences were observed between groups in fall-related outcomes (e.g., medically treated falls odds ratio [adjusted for SIS]: 0.741; 95% CI: 0.411-1.336).

DISCUSSION AND IMPLICATIONS: Although no significant differences were found, limited recruitment, low baseline fall rates, and unmeasured adherence may have impacted results. Further research is needed to evaluate the feasibility and effectiveness of telemedicine-based STEADI interventions in primary care.