STRIDE: A PRAGMATIC TRIAL OF A MULTIFACTORIAL APPROACH TO REDUCE SERIOUS FALLS INJURIES
Reuben DB., Gill TM., Lamb S.
Abstract Among older adults, falls are the leading cause of both fatal and nonfatal injuries. In 2014, the Patient-Centered Outcomes Research Institute (PCORI) and the National Institute on Aging (NIA) funded a pragmatic trial to develop and test an intervention that would be integrated into the provision of clinical care in 10 US health care systems with the aim of reducing serious falls-related injuries. Within the 10 health systems, 86 practices (43 intervention and 43 control) and 707 primary care physicians (348 intervention and 359 control) are participating. Both central and clinic-based screening are being utilized followed by centralized recruitment. By Spring 2017, STRIDE will have recruited 5322 participants aged 73 years or older and will follow them for an average of 2.5 years. The STRIDE intervention is patient-centered and based on identification and co-management of up to 8 personal risk factors (medications, postural hypotension, feet and footwear, vision, vitamin D, osteoporosis, home safety, and strength, gait, and balance impairment) by a registered nurse. Interventions for specific risk factors are evidence-based and can be implemented within health care systems and community-based organizations. Several approaches, including self-report, electronic health care records, and claims data, are being used to ascertain and verify the primary and several secondary outcomes. At each step, barriers to conducting the study have surfaced and solutions to overcoming these barriers have been implemented. These study barriers and their solutions provide lessons for conducting pragmatic trials in older persons, implementing interventions, ascertaining outcomes, and diffusing research findings into clinical care.