Patient-stimulated fall prevention screening in primary care: analysis of provider coding changes

Background: The Centers for Disease Control and Prevention (CDC) has developed an evidenced based clinical screening tool, Stopping Elderly Accidents, Deaths & Injuries (STEADI) but penetration into routine clinical practice has been slow. To increase screening for falls and fall risk in an internal medicine primary care practice, a patient-centered screening program was integrated into a busy academic clinic.

Methods: Over a three month period, Patients were invited to self-screen via a large poster in the waiting room, and complete a STEADI Staying Independent questionnaire, and discuss findings with their healthcare provider. Fall Prevention Booklets were made readily available in clinic exam rooms. Questionnaires and fall prevention booklets, were uniquely numbered, and Epic Slicer-Dicer reports were utilized to evaluate falls screening-related ICD-10 codes determined a priori. Generalized linear modeling calculated difference-in-difference compared with other clinics without this program for rates of coding for fall-related diagnosis codes.

Results: In three months, 255 questionnaires were taken; only 5 (2%) were returned for later review. 110 booklets were disseminated from clinic exam rooms. The absolute difference-in-difference in ICD-10 coding was 0.7% compared to other clinics in the same practice, and year before. Generalized linear modeling showed a 4.7% increased impact in screening-related ICD-10 codes, which was statistically significant (P = < .0001) without reported disruption to clinical workflows.

Conclusion: There are indicators that patient-centered selective screening at a busy academic practice may have resulted in an increase in falls-related ICD-10 coding. Clinical integration of this program was well received.