Increasing Wisconsin s Engagement in Fall Risk Screening Becky Turpin, MA Adult Injury Prevention Coordinator, UW Health Jane Mahoney, MD Professor of Medicine, Geriatrics
System Goal All older adults screened for fall risk and referred to appropriate evidence-informed interventions The following are the three steps we see to get to this goal and examples of how we are moving within each 1. Screening 2. Implementing evidence-informed interventions 3. Assuring there are evidence-informed strategies for everyone
The STEADI toolkit what is it? Developed by CDC Based on American Geriatrics Society recommendations Recommended screening and intervention approach for clinic Triages patients to 3 levels of intervention
STEADI why is medical evaluation Find reversible conditions hypothyroidism important? Vitamin D or other vitamin deficiency Vision impairment/cataracts Change medications Decrease doses of sleepers, antidepressants, anti-anxiety medications Prescribe physical therapy
STEADI connects... Clinical Practice Community-Based Fall Prevention Programs
Making it easier to implement effective community-based fall prevention programs +
STEADI What is community s role? Identify people at risk for falls Recommend they talk to their doctor Explain benefit of medical evaluation Community-based programs proven to reduce falls Stepping On Tai Chi Moving for Better Balance, Tai Chi Fundamentals, Tai Chi arthritis
STEADI Materials http://www.cdc.gov/steadi/
Steps to save lives and save costs 1 SCREEN for fall risk Getting Started 2 3 REVIEW and manage medications linked to falls RECOMMEND daily vitamin D supplements Trainings that Target Multiple Audiences Insights from current users
STEADI Implementation One Example Current status with STEADI at UW Health Ongoing efforts for improvement
Integrating Stepping On into a Health System Acknowledgements: Principal Investigator Hee Soo Jung, MD, Jody Janczweski, DPT, UW Health Learning Center Funding Acknowledgement Research reported in this report was supported by the Clinical and Translational Science Award Program within the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Integrating Stepping On 1 year, $5,000 grant Goals into UW Health - Train 2 Nurses as Leaders - Host 2 Workshops @ UW Health Clinics Create a Sustainable program Sustainability defined as 4 classes per year without grant funding
Implementation Process Pre-grant Identify appropriate leaders Appropriate from a SO perspective as well as an organizational perspective Grant period Build the infrastructure Display board Guest expert pool Registration Marketing Referral Continuous Gather Information o Patient/Family Focus Group, Leadership Groups, Stakeholder interviews and survey s, participants
www.uwhealth.org/steppingon
Implementation Barriers Staff Time Outside normal cost structure Outside normal work flow Training additional leaders Storage Snack procurement Referrals/competing interests
LCD Screen Displays in Hospital & Clinics
Stepping On Referral Sources Internal Referral Other = Non-UW Health providers, Parkinson's support group, senior centers, Safe Communities
Facilitators Community partners Willingness to try End goal in mind Staff satisfaction Champions Organizational goal alignment Oh I just had the best morning!!!! I had my first Stepping On class and it was just the best!!!!! Population Health, Trauma Verification, Learning Center Mission, Magnet Designation, Accountable Care Organization requirements
Stepping On Workshops at UW Health Date of Workshop Location # of registered participants 07/08/2014 08/19/2014 UW Health Research Park 14 Grant period 10/23/2014 12/11/2014 UW Health West Clinic 14 2/4/2015 3/18/2015 UW Health Yahara Clinic 14 5/13/2015 6/24/2015 UW Health AOB 8 8/26/2015 10/14/2015 UW Health Research Park 16 11/2/2015 12/14/2015 UW Health East Clinic 10 02/8/2016 3/21/2016 UW Health West Clinic 17 4/14/2016 5/26/2016 UW Health West Clinic 12 6/9/16 7/21/2016 UW Health at The American Center 8 Upcoming 8/8/16 UW Health Northeast Clinic TBD Upcoming 10/31/16 UW Health at The American Center TBD TOTAL Registered (to date) 113
Lessons Learned Have a clear goal Hold people to their word Just Ask Leader training, unity reimbursement Designated staff for coordination up front to build the process and infrastructure Clearly identify all tasks and designate roles in writing Tie the effort to as many organizational goals as possible
CAARN s new falls prevention programs where are they at? Modifications of proven programs Stepping Online Tai Chi Fundamentals Pisando Fuerte LiFE Programs being tested for outcome of falls (not yet proven) Yoga for seniors Reducing falls risk medications (Mott)
CAARN Falls Prevention Projects Stepping Online (Cont.) For Stepping On graduates getting ready for small randomized trial Tai Chi Fundamentals Testing a program that fits in senior center schedule of 8-12 weeks Adding intervention to increase home practice Randomized trial just starting!
CAARN Falls Prevention Projects Pisando Fuerte (Cont.) Stepping On has been culturally and linguistically translated to Spanish We implemented and evaluated it in two settings Currently analyzing results and finishing manual edit
CAARN Falls Prevention Projects LiFE program Implementation tested with Aspirus home health Fidelity was poor overall; needs better training Yoga for Seniors (Cont.) Yoga adapted for seniors by Paul Mross Pilot tests (pre-post) show improved balance Getting ready to apply for funding for randomized trial to see if it reduces falls
CAARN Falls Prevention Projects (Cont.) Reducing Falls Risk Medications in Older Adults David Mott, Pharm D, Professor of Pharmacy Excellent results in pilot test with Stepping On graduates Pharmacist evaluates medications and recommends to MDs how to change medications Looking for funding for randomized controlled trial
Implementing STEADI in EHRs Falls coalitions Next steps WIHA s work to link Stepping On with healthcare systems
STEADI Implementation Focus on four priority areas to making fall prevention a routine part of clinical care 1 Health System Implementation Develop EHR and other clinical decision support tool integration, prevent fall-related hospital readmissions, promote team-based care, link to community-based programs 2 Billing, Reimbursement, and Provider Incentives Develop CPT Category 1 Codes, generate CMS Quality Measures and incentive programs, support USPSTF recommendations 3 Training and Education Educate providers through various continuing medical education activities (CME) and the provision of educational tools and resources 4 Translation and Communication Conduct research on the burden of falls and effective interventions, develop tools & resources for a variety of audiences including providers, health systems, and the public
WI Fall Prevention Initiative The group is open to all that believe in the mission and want to help refine and achieve the goals: Increase education of medical community, frontline staff, care managers, caregivers, and consumers Promote continued and successful collaborations between social and medical disciplines that deliver health services and support Identify and promote evidence-based activities and programming statewide Mission Statement: The Mission of the Wisconsin Falls Prevention Initiative is to reduce falls and fall-related complications and deaths among Wisconsin s older adults through the integration of community based and medical prevention approaches. Meetings: 2 nd Thursday every other month 1:30-3:00 pm via conference call (Conference line hosted by the WI Department of Health Services)
WIHA s successes with integrating Stepping On with health care systems Different approaches to healthcare partnerships Some partnerships took years, while others were successful in a few months Best Practices
Discussion Sharing successes with community medical piece Front end having the community get people in to be seen by their doctor about falls How do we talk to people about importance of talking to their doctor Back end having doctors refer back to the community for falls programs