Research Summary

EHR-Integrated Decision Support Had Modest Reduction in Falls in Seniors

Edited by:
Ashton L. Stahl

Key Highlights

 

  • The eSTEPS trial included 11,945 older adults at increased fall risk across 22 primary care practices.
  • The rate of patients with at least one coded fall was 19.3 versus 21.2 per 100 patient-years with intervention versus usual care.
  • Fall-related injuries were also reduced, while mortality did not differ.
  • Exercise prescriptions reached 22.1% of intervention patients, and patient adherence data were unavailable.

An electronic health record (EHR)–integrated clinical decision support intervention modestly reduced recorded falls and fall-related injuries among older primary care patients, according to a cluster randomized trial published in JAMA Network Open. Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS) provided clinicians with tailored exercise recommendations and patient resources as part of routine care.

The US study included 11,945 community-dwelling adults aged ≥65 years at 22 Mass General Brigham primary care practices. Participants had a positive 3-item fall-risk screen addressing previous injurious falls, recurrent falls, or fear of falling because of balance or walking problems.

Practices were matched by type and size and randomized to eSTEPS or usual care. The trial ran from June 9, 2023, through May 8, 2025, with 12–23 months of follow-up. Mean participant age was 77.05 years, and 67.3% were female.

The intervention used a non-interruptive EHR alert and order set that offered tailored strength and balance exercises, an optional physical therapy referral, and handouts, a website, and an app. Exercises required no additional equipment and were designed for approximately 10-minute home sessions. Usual care included fall-risk screening and opportunities for physical therapy referral. The primary outcome was the rate of patients with at least one fall identified through ICD-10 diagnostic codes.

Study Findings

The rate of patients with at least one coded fall, including falls with injuries, was 19.3 per 100 patient-years in intervention practices versus 21.2 in control practices (rate ratio [RR], 0.91; 95% CI, 0.88–0.95; P < .001). Fall-related injury rates were 15.7 versus 16.7 per 100 patient-years, respectively (RR, 0.94; 95% CI, 0.90–0.97; P = .001). Mortality did not differ between groups.

Among 5,681 intervention patients, 1,255 (22.1%) received an eSTEPS exercise prescription. Overall, 215 clinicians (77.9%) in intervention practices used the decision support to deliver the exercise program at least once.

Clinical Implications

According to the authors, EHR-integrated decision support may support scalable fall prevention in primary care. They recommended further work to improve uptake, optimize workflow integration, and evaluate effectiveness across diverse settings and EHR systems.

Limitations included reliance on diagnostic codes, which may underestimate falls or introduce differences in detection between groups. Variable uptake, implementation within one health system and EHR platform, and unavailable patient adherence data limited generalizability and understanding of how the intervention produced its effects.

Expert Commentary

“These findings demonstrate that evidence-based fall prevention can be successfully integrated into routine primary care workflows, providing a scalable strategy for reducing falls in large populations of older adults,” the researchers concluded.

Reference

Latham NK, Hommel E, Kiesman M, et al. Clinical decision support for fall prevention in primary care: the eSTEPS cluster randomized clinical trial. JAMA Netw Open. 2026;9(10). doi:10.1001/jamanetworkopen.2026.39240