eSTEPS modestly reduced older-adult falls

Electronic decision support modestly reduced falls and fall injuries in at-risk older primary care patients.
*Cluster randomized clinical trial; Level 2 (OCEBM 2011).

Citation

Latham NK, Hommel E, Kiesman M, et al. Clinical Decision Support for Fall Prevention in Primary Care: The eSTEPS Cluster Randomized Clinical Trial. JAMA Network Open. 2026;9(10):e2639240. doi:10.1001/jamanetworkopen.2026.39240

Background

Falls are a major cause of injury in older adults. Exercise helps prevent falls, but primary care implementation is often limited by time and workflow barriers.

Patients

11,945 community-dwelling adults aged 65 years or older with a positive fall-risk screen in 22 US primary care practices. Excluded were practices without data access and patients not screened or not at increased fall risk.

Intervention

Electronic health record–embedded eSTEPS support with tailored home strength and balance exercises, patient materials, and optional physical therapy referral.

Control

Usual care: fall-risk screening and possible physical therapy referral, without eSTEPS tools.

Outcome

Primary: rate of patients with at least 1 coded fall. Secondary: coded fall-related injuries and death.

Follow-up Period

12 to 23 months; mean about 622 days.

Results

Outcome Intervention Control Effect
Coded falls, per 100 patient-years (primary) 19.3 (95% CI 18.6 to 20.1) 21.2 (95% CI 20.2 to 22.1) RR 0.91 (95% CI 0.88 to 0.95); NNT 29 over 2 years
Coded fall injuries, per 100 patient-years 15.7 (95% CI 15.0 to 16.5) 16.7 (95% CI 16.1 to 17.4) RR 0.94 (95% CI 0.90 to 0.97)
Self-reported falls or injuries, per 100 patient-years 17.5 (95% CI 16.9 to 18.0) 19.2 (95% CI 18.7 to 19.6) RR 0.91 (95% CI 0.87 to 0.95)

Results were analyzed by assigned practice group. Usual care was the available current treatment. Mortality did not differ.

Limitations

Falls were identified mainly from medical record codes, which may miss events. Only 22.1% received exercise prescriptions. Single health system and one record platform limit generalizability. Absolute benefit was modest.

Funding

NIH/NIA funded; funder had no role. Some outside industry ties.

Clinical Application

Consider workflow-integrated fall-prevention prompts for at-risk older adults; benefit is modest but scalable and supports exercise-based prevention.