DNP 740 Week 4 Surveillance and Screening Programs Example

Nineteen Percent Screened: Designing Fall Risk Screening and Surveillance for a Rural County's Older Adults With STEADI, a Federal Recommendation and Ambulance Data

[Student Name]

University of Phoenix

DNP/740: Clinical Prevention and Population Health

Week 4 Assignment

[Instructor Name]

[Date]

The county and figures are composites written for a model paper.

Our clinic screened only 19% of patients 65 and older for fall risk last year. Countywide, most older adults are never asked. Meanwhile, ambulance crews respond to more than 600 fall calls a year, and many of those residents are never connected to prevention. This paper designs a screening program and a surveillance system.

Screening Versus Surveillance

Screening identifies individuals at risk so they can be offered intervention. Surveillance is the ongoing, systematic collection, analysis and use of population data to track a problem and guide action. Our program needs both: screening to reach individuals and surveillance to see whether the county's burden is changing.

The STEADI Approach

Stevens and Phelan (2013) describe how the national injury center built STEADI from the American and British Geriatrics Societies' guideline, interviews with clinicians and focus groups. The toolkit helps clinicians incorporate fall risk screening and individualized interventions into routine practice and connect clinic care to community prevention resources. Its brief screen asks three things: any fall in the last twelve months, any sense of unsteadiness on one's feet and any worry about falling.

What the Federal Recommendation Supports

The current federal task force statement gives a B grade to exercise for older adults living at home who face elevated fall risk and asks clinicians to individualize the decision to offer multifactorial interventions, a C recommendation, because the overall net benefit of routinely offering them is small (US Preventive Services Task Force, 2024). This shapes what follows a positive screen: exercise referral for all at increased risk, with multifactorial assessment for selected patients, such as those with multiple falls or injury.

A screen that finds risk and leads nowhere is a survey; this one had to end in a class, a home visit or a medication change.

Where to Screen

Screening in the clinic reaches only patients who visit. To reach the population, screening will occur in four places: the clinic at every visit for patients 65 and older, through the three STEADI questions in the intake form; the senior center and meals program, by trained volunteers; township churches during monthly health days; and emergency medical services lift-assist and fall calls, where crews ask the three questions and, with consent, refer to the clinic.

Follow-Up for Positive Screens

A positive screen triggers a gait and balance check, such as the timed up and go test, by a nurse at the clinic or during a health day. All at increased risk are referred to an exercise program. Those with repeated falls, injury or multiple risk factors receive a multifactorial assessment including medication review, vision, feet and a home safety assessment, consistent with the individualized approach in the federal recommendation.

Why Three Questions

Longer assessments are more accurate but impractical in churches and ambulances. Three questions take under a minute, can be asked by trained volunteers and identify those who need a fuller assessment. The trade-off is some false positives, which the follow-up gait check sorts out.

Linking Ambulance Calls to Clinics

Emergency medical services lift-assist calls are a signal of high risk. With a data-sharing agreement and resident consent, crews will send a referral to the clinic within 24 hours, and a nurse will call within three days to offer a visit or home assessment.

Referral Pathways

For each positive screen, the referral goes to the clinic's fall prevention nurse, who logs it and assigns the next step: gait check, exercise enrollment or multifactorial assessment. A single point of referral keeps positive screens from being lost between organizations.

Surveillance Design

Surveillance will track, quarterly: fall-related ambulance calls per 1,000 older residents, with lift assists reported separately; emergency visits for falls; hip fracture admissions; fall deaths using three-year averages; screening rates by setting; and referral completion rates. Data will be broken down by township and age group to track the distribution.

Using National Surveillance

National surveillance shows that about 27.5% of older adults report falling and about 10% report a fall injury each year (Moreland et al., 2020), which gives a benchmark for our regional estimates.

The state's regional survey estimates, collected every two years, will provide a check on self-reported falls in the population, although they cannot be broken down to townships.

Training Screeners

Volunteers and ambulance crews will learn the three questions, how to explain their purpose and how to make a referral with consent. A short script helps them avoid alarming residents while taking concerns seriously. Screeners will also learn to recognize urgent situations, such as a fall with a head injury, that need immediate care rather than referral.

Tracking Individuals Across Settings

A simple shared registry, maintained by the clinic with residents' consent, will record screening results from all settings so that a person screened at church and again by an ambulance crew is recognized as one person, and follow-up is not duplicated or missed.

Ethical Considerations

Screening should lead to benefit. Screening people without offering accessible interventions, especially in remote townships, raises ethical concerns. The program will not expand screening to a setting until exercise classes or home visits are available there.

Screening Frequency

Screening will then be repeated annually for all those who screen negative and at every visit for those who screened positive, since risk changes with illness, new medications and aging. A fall reported at any contact triggers rescreening regardless of the schedule.

Resources

Volunteers will be trained in a one-hour session; ambulance crews will add three questions to their run reports; the clinic's intake form change costs nothing. The main cost is the nurse time for follow-up calls and assessments, estimated at one half-time nurse funded through the health department's prevention grant for the first two years, with the clinic absorbing the cost afterward if referral volume justifies it and outcomes show benefit to patients.

Measuring the Screening Program

The program itself needs evaluation, separate from falls outcomes. A drop in ambulance calls could reflect a mild winter as easily as better prevention, so the screening process has to be judged on its own terms first.

Measures include the percentage of older clinic patients screened, number screened in community settings, percentage of positive screens receiving a gait assessment and percentage referred who attend an exercise program.

Surveillance Reports

A quarterly two-page surveillance report will go to the health board, clinic leadership, emergency medical services and the area agency on aging, with charts by township and age group. Shared reporting keeps all partners looking at the same picture and allows early course corrections.

Conclusion

Only a fifth of our older clinic patients were screened for fall risk, and most older residents were never asked. A screening program built on STEADI's three questions, delivered in clinics, community sites and ambulance calls, connects positive screens to exercise for all at risk and individualized multifactorial assessment for some, consistent with the federal recommendation. Surveillance using multiple local sources, broken down by township and age, will show whether the county's burden and its distribution change.

References

Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years: United States, 2012-2018. Morbidity and Mortality Weekly Report, 69(27), 875-881. https://doi.org/10.15585/mmwr.mm6927a5

Stevens, J. A., & Phelan, E. A. (2013). Development of STEADI: A fall prevention resource for health care providers. Health Promotion Practice, 14(5), 706-714. https://doi.org/10.1177/1524839912463576

US Preventive Services Task Force. (2024). Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA, 332(1), 51-57. https://doi.org/10.1001/jama.2024.8481