Community-FIT: A Systems Science Approach to Fall Prevention
On September 1, 2017, while at a local arts festival, a research coordinator from our team struck up a conversation about the immense challenge of preventing falls among older adults with paramedics from a local fire station (Upper Arlington Fire Division). The research coordinator shared the highlights of their discussion with me and several other faculty members at The Ohio State University later that week during our team meeting. We realized that despite having a large repertoire of evidence-based fall prevention interventions already available in the community, there were clear implementation gaps given these interventions were not consistently reaching people at the greatest risk for falls. The fire/paramedic agency was interested in being more proactive in injury prevention in their community with a focus on reducing the system-level burden of the number of recurrent fall-related 9-1-1 calls among highly vulnerable members in their community. Consequently, we decided to reach out to the fire station leaders to see how we might be able to collaborate with them to “wrap” our collective arms around the most vulnerable people in the community to get effective fall prevention solutions into the homes of people who most needed them.
We began the partnership with a series of brainstorming activities using systems thinking and modeling methodologies to identify potential leverage points for creating transformative solutions. We then utilized an implementation science framework combined with improvement science tools and strategies (i.e., Gemba walks, key driver diagramming, process mapping, control charts) to plan and implement a novel system-level solution. Collectively, the group agreed that implementing fall prevention efforts that could radically reduce recurrent falls among the most vulnerable would necessitate strategies that addressed the complex nature of our health system’s care coordination processes. Through iterative plan-do-study-act cycles, our team was able to develop a system of processes, feedback loops, and care coordination strategies to provide personalized fall prevention care to citizens in the community identified as “high-risk.” The resulting activities led to over a sustained 60% reduction in the number of fall calls and fall-related transports to the hospital serviced by the fire/paramedic agency.
Applied LeaRRning Case
Dr. Quatman-Yates, PT, DPT, PhD, is a faculty member and clinical rehabilitation services consultant at The Ohio State University. This applied learning case describes a partnership between an academic health system and community-based fire/paramedic agency to develop and implement a systems-level fall prevention intervention. We used a community-based participatory action research approach and a combination of systems science, implementation science, and improvement science methods to radically reduce the number of fall-related 9-1-1 calls and hospital transports in a community.
“When multi-sector partners engage in systems thinking and modeling, the solutions that emerge can be surprising, sustainable, and transformative.”
Catherine Quatman-Yates, PT, DPT, PhD