Primary care EHR tool helps prevent falls in older adults

Clinical takeaway: Consider incorporating structured fall-risk assessment and exercise recommendations into routine primary care visits for older adults. An EHR-integrated decision support tool produced modest but meaningful reductions in falls and fall-related injuries in a large real-world trial.

Falls remain a leading cause of injury, hospitalization, and loss of independence among older adults, yet proven exercise-based prevention strategies are difficult to implement consistently in busy primary care settings. Researchers developed eSTEPS, an EHR-integrated clinical decision support tool designed to make fall prevention easier to deliver during routine care.

In the cluster-randomized eSTEPS trial, investigators enrolled nearly 12,000 adults aged 65 years or older who screened positive for fall risk across 22 primary care practices in the Mass General Brigham system. Patients were followed for roughly 20 months on average. The intervention embedded tailored strength and balance exercise recommendations, optional physical therapy referral, and patient education resources directly into the EHR workflow.

Patients treated in intervention practices experienced about 19 falls per 100 patient-years compared with 21 falls per 100 patient-years in usual-care practices, representing an approximately 9% relative reduction. Fall-related injuries were also reduced by about 6%, from 16.7 to 15.7 events per 100 patient-years. Over 2 years, an estimated 32.0% of intervention patients experienced at least one fall compared with 34.5% of controls, translating to roughly one prevented fall for every 29 patients exposed to the intervention.

Benefits were observed despite relatively modest uptake: clinicians issued exercise prescriptions to 22% of eligible patients, although nearly 78% of clinicians used the tool at least once during the study. Researchers also found a small reduction in hospitalizations, while mortality was unchanged. Effects were generally greater among adults aged 76 years or older.

The authors concluded that the findings show “evidence-based fall prevention can be successfully integrated into routine primary care workflows,” offering a scalable strategy to reduce falls across large populations of older adults.

In an accompanying editorial, Junyi Peng, BMed, Rebecca Ivers, PhD, and Maoyi Tian, PhD, noted that the absolute benefits were modest but could have substantial population-level impact if implemented broadly. They argued that eSTEPS succeeds by embedding fall prevention within existing primary care systems rather than creating separate programs, and suggested that pairing digital tools with caregiver, community, and behavioral support could further improve long-term participation in exercise.

Source: Latham NK, et al. (2026 Oct 16) JAMA Netw Open. Clinical Decision Support for Fall Prevention in Primary Care: The eSTEPS Cluster Randomized Clinical Trial