Clinical Scorecard: Integrating Flexible Fall-Prevention Strategies Into Primary Care: Modest Changes, Wider Impact

At a Glance

Key Highlights

• The eSTEPS matched-pair cluster randomized trial included 11,945 adults aged 65 years or older across 22 primary care practices.
• The EHR tool provided a noninterruptive care-gap alert, individualized strength and balance exercises, optional physical therapy referral, and patient-facing materials.
• Adjusted outcome rates favored intervention practices for ICD-10–coded falls, ICD-10–coded fall-related injuries, and participant-reported falls or injuries.
• Absolute differences were approximately 1.9 fewer patients with a recorded fall and 1.0 fewer with a recorded fall-related injury per 100 patient-years.
• Exercise prescriptions were provided to 22.1% of patients in intervention practices; the trial did not include an economic evaluation.

Guideline-Based Recommendations

Diagnosis

• The eSTEPS workflow incorporated fall-risk identification and clinical decision-making into routine primary care; the article does not specify a diagnostic protocol.

Management

• The eSTEPS intervention offered individualized strength and balance exercises and an optional physical therapy referral.

Monitoring & Follow-up

• eSTEPS supplied participant-facing materials through print resources, after-visit summaries, a website, and a mobile application.
• The article notes that digital systems can extend exercise instruction, monitoring, reminders, and behavior-change support beyond the clinical encounter.

Risks

• The article identifies health limitations, financial expenses, transportation barriers, limited availability of appropriate services, and personal beliefs about falls and exercise as potential barriers to participation.
• Digital approaches may need to account for differences in technology access and digital literacy among older adults.

Patient & Prescribing Data

The eSTEPS cohort included 11,945 adults aged 65 years or older; mean age was 77.1 years, 67.3% were women, and 81.6% had a Charlson Comorbidity Index of 2 or higher.

Exercise prescriptions were provided to 22.1% of patients in intervention practices. The article notes that exercise prescription alone does not establish sustained behavioral change and discusses supplementary behavioral and social support.

Clinical Best Practices

• Integrate fall-risk identification, clinical decision-making, exercise prescription, referral options, and patient resources into established primary care workflows.
• Consider supplementary behavioral and social support to help older adults begin and continue exercise participation.
• The article describes a potential model combining EHR-based identification and exercise prescription with caregiver participation, community engagement, and suitable human support.

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