Background and Significance Falls in community-dwelling older adults are common, and there is a lack of clinical decision support (CDS) to provide health care providers with effective, individualized fall prevention recommendations.
Objectives The goal of this research is to identify end-user (primary care staff and patients) needs through a human-centered design process for a tool that will generate CDS to protect older adults from falls and injuries.
Methods Primary care staff (primary care providers, care coordinator nurses, licensed practical nurses, and medical assistants) and community-dwelling patients aged 60 years or older associated with Brigham & Women's Hospital-affiliated primary care clinics and the University of Florida Health Archer Family Health Care primary care clinic were eligible to participate in this study. Through semi-structured and exploratory interviews with participants, our team identified end-user needs through content analysis.
Results User needs for primary care staff (n = 24) and patients (n = 18) were categorized under the following themes: workload burden; systematic communication; in-person assessment of patient condition; personal support networks; motivational tools; patient understanding of fall risk; individualized resources; and evidence-based safe exercises and expert guidance. While some of these themes are specific to either primary care staff or patients, several address needs expressed by both groups of end-users.
Conclusion Our findings suggest that there are many care gaps in fall prevention management in primary care and that personalized, actionable, and evidence-based CDS has the potential to address some of these gaps.
Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. The purpose of this study was to compare treatment outcomes between surgical and nonsurgical care of distal radius fractures to inform evidence-based guidelines for the management of distal radius fractures. A retrospective chart analysis was performed in the public university hospital setting on a sample of 60 patient health records divided equally into those treated surgically and nonsurgically. Data were analyzed related to specific variables in those patients who met specific inclusion/exclusion criteria. Analysis identified that patients treated surgically experienced improved healing and return of range of motion. There was no statistical significance comparing pain in both the surgical and nonsurgical groups. Diabetes and smoking were found to have a negative impact on healing and clinical outcomes. Despite limitations, this pilot project serves as a baseline for future research regarding best practices in the treatment of distal radius fractures. It also demonstrates the negative impact that diabetes and smoking can have on clinical outcomes.
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