{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:55:31Z","timestamp":1792166131197,"version":"4.4.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Falls are a leading cause of injury among older adults. Although exercise reduces fall risk, implementation in primary care remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether an electronic health record\u2013integrated clinical decision support intervention, Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS), reduces falls among older primary care patients at increased risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This matched-pair cluster randomized clinical trial was conducted from June 9, 2023, to May 8, 2025, with 12 to 23 months of follow-up at primary care practices within an integrated health system in the US. Adults aged 65 years or older with a positive 3-item fall-risk screen at a primary care visit were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>eSTEPS decision support embedded in the electronic health record with tailored exercise recommendations, optional physical therapy referral, and patient-facing materials (handouts, website, and app).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>\n                      The primary outcome was the rate of patients with 1 or more falls identified using electronic health record\u2013derived\n                      <jats:italic>International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic>\n                      (\n                      <jats:italic>ICD-10<\/jats:italic>\n                      ) diagnostic codes. Secondary outcomes were the rate of patients with 1 or more fall-related injuries identified by validated\n                      <jats:italic>ICD-10<\/jats:italic>\n                      algorithms and mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 11\u202f945 participants (mean [SD] age, 77.05 [7.43] years; 8044 females [67.3%]), of whom 5681 (47.6%) were in the intervention group and 6264 (52.4%) were in the control group, at 22 primary care practices, the rate of 1 or more\n                      <jats:italic>ICD-10<\/jats:italic>\n                      \u2013coded falls (including falls with injuries) per 100 patient-years over the study period was 19.3 (95% CI, 18.6-20.1) in patients from intervention practices vs 21.2 (95% CI, 20.2-22.1) in patients from control practices (rate ratio [RR], 0.91 [95% CI, 0.88-0.95];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). The rate of\n                      <jats:italic>ICD-10<\/jats:italic>\n                      \u2013coded fall-related injuries per 100 patient-years was 15.7 (95% CI, 15.0-16.5) from intervention practices vs 16.7 (95% CI, 16.1-17.4) from control practices over the study period (RR for fall injuries per 100 patient-years, 0.94 [95% CI, 0.90-0.97];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001). No differences were observed in mortality. For intervention patients, eSTEPS exercise prescriptions were issued for 1255 patients (22.1%). Overall, 215 clinicians (77.9%) in intervention practices used the clinical decision support to deliver the exercise program at least once over the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cluster randomized clinical trial of an electronic health record\u2013integrated decision support, falls and fall-related injuries were modestly reduced in older adults in primary care. These results suggest support for scalable, workflow-integrated fall prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04993781?term=NCT04993781&amp;amp;amp;viewType=Card&amp;amp;amp;rank=1\">NCT04993781<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.39240","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:30:25Z","timestamp":1792164625000},"page":"e2639240","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Decision Support for Fall Prevention in Primary Care"],"prefix":"10.1001","volume":"9","author":[{"given":"Nancy 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