The STRIDE Intervention: Falls Risk Factor Assessment and Management Patient Engagement and Nurse Co-management

摘要

In response to the epidemic of falls and serious falls-related injuries among older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention and an enhanced usual care intervention.The STRIDE multifactorial intervention consists of 5 major components delivered by registered nurses in the role of Falls Care Managers (FCM), who co-manage fall risk in partnership with patients and their primary care providers (PCP). The components include: 1) standardized assessment of 8 modifiable risk factors (medications, postural hypotension, feet and footwear, vision, vitamin D, osteoporosis, home safety, and strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; 2) explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; 3) co-creation of individualized Falls Care Plans that are reviewed, modified, and approved by patients’ PCPs; 4) implementation of the Falls Care Plan; and 5) ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the Falls Care Plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management.The trial testing the effectiveness of the STRIDE intervention is in progress with results expected in late 2019.