BUILDING THE EVIDENCE BASE FOR FALLS PREVENTION: THE CDC’S STEADI INITIATIVE

Abstract

The Centers for Disease Control and Prevention (CDC) created the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative, based on American and British Geriatric Society Guidelines to assist healthcare providers in preventing older adult falls. Core elements were defined to allow health systems to implement STEADI with fidelity while adapting it to their unique clinical practice. These elements include: screening older patients for fall risk, assessing at-risk patients to identify modifiable risk factors, and intervening by recommending evidence-based strategies. Similar strategies using a multifactorial approach are associated with a 24% reduction in the rate of falls. CDC’s evaluation strategy includes determining the cost effectiveness of STEADI in preventing older adult falls, and understanding implementation best practices including: defining core elements across different settings, ensuring feasibility and acceptability to healthcare providers, and increasing patient adherence to prescribed strategies. STEADI is being implemented and evaluated in outpatient practices in Oregon, New York, and Pennsylvania, and for use in inpatient units to reduce fall-related readmissions in California. In addition, an evaluation of optimal fall-risk screening methods for identifying at-risk patients is ongoing. Each project requires decisions on how to implement STEADI with fidelity; utilize the full capacity of multiple provider types; and incorporate complex patient work-flows and unique clinical standards and requirements. Balancing data collection cost with obtaining adequate evaluation data is a critical consideration. Understanding the results of these evaluations to-date, demonstrates the complexity of implementing and evaluating multifactorial fall prevention strategies.