The Effect of an Intensive Geriatric Continuing Medical Education Program on the Implementation of STEADI-Based Fall Risk Screening

Abstract

Background: Universal fall risk screening as a first step to address falls has been endorsed in primary care but remains challenging due to competing clinical priorities and insufficient training. We studied the impact of our geriatric continuing medical education program, the Geriatric Mini-Fellowship (GMF), on the uptake of fall risk screening in primary care over a 5-year period. We hypothesized that primary care providers (PCP) with exposure to the GMF program would be more likely to implement fall risk screening than PCPs without direct or indirect program exposure. Population and Setting: We identified 133,068 patients ≥ 65 years of age who received care at primary care clinics in a large health system. Methods: Each year, we retrospectively assigned patients to one of three groups based on their provider's exposure to the GMF program. Groups included patients seen by: GMF providers who completed GMF training. GMF-influenced providers who practiced at a clinic with at least one GMF provider. Usual care providers who neither completed GMF training nor worked at a clinic with a GMF provider. We described fall risk screening rates and patterns using multivariate models to estimate the predicted probability and odds of being screened each year based on a provider's training exposure. Results: GMF providers were associated with a greater predicted probability of screening patients for fall risk compared to usual care providers each year. Differences in predicted probabilities between GMF providers and usual care with bootstrapped confidence intervals favored GMF providers. Further, this screening advantage increased over time (2019: 5.8%, 2023: 12%). Conclusions: Our data supports intensive fall risk education on screening through a geriatrics training program to implement sustained fall risk screening in primary care. Screening is the first step in identifying high-risk patients, which can enable assessment of modifiable risk factors and lead to targeted interventions.