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Keywords: fall prevention, patient barriers, quality improvement

Background

Falls are a leading cause of injury and mortality for adults aged 65 and older. Although evidence-based interventions exist, their translation into practical settings has yielded only modest results. As a retrospective cohort study of the UCLA Geriatrics Fall Prevention Clinic demonstrated low implementation rates of key recommendations, this project aimed to identify barriers to implementation and whether post-clinic phone follow up would improve rates of adherence.

Current Condition

The UCLA Geriatrics Fall Prevention Clinic is an interprofessional, consultative clinic that conducts an evidence-based fall risk evaluation and provides individualized interventions. However, these recommendations are not easily translated into actionable care, as demonstrated by poor rates of adherence, and consequently, may have little impact on improving clinical outcomes.

Target Condition

The goals of this project are two fold: (1) to identify challenges patients face post-clinic to implementing recommendations, and (2) to evaluate whether a dedicated phone-based care coordinator will facilitate referral and recommendation completion.

Gap Analysis

Some gaps include competing care priorities or confusion regarding logistics, as some referrals may require patients to call and schedule, whereas others may reach out first. Additionally, fall risk assessments and interventions are time-intensive, which may limit feasibility in real-world settings.

Countermeasures

Introducing a phone-based care coordinator who clarifies next steps and assists with referral logistics may help identify patient specific-barriers and reduce fall-related outcomes over time by addressing these gaps and improving adherence to recommendations.

Action Plan

Patients will receive a follow-up call approximately 8 weeks post-visit to review recommendations, identify barriers, and assist with referral follow-up. The care coordinator will also chart review to assess for primary care follow-up and reinforcement of these recommendations longitudinally.

Next Steps

Insights into common logistical and patient-level barriers can inform potential system-level changes that will help increase the clinical impact of fall prevention clinics and decrease the gap between strategies and real-world applications.