Objectives: Falls are persistent among community-dwelling older adults despite existing prevention guidelines. We described how urban and rural primary care staff and older adults manage fall risk and factors important to integration of computerized clinical decision support (CCDS).
Methods: Interviews, contextual inquiries, and workflow observations were analyzed using content analysis and synthesized into a journey map. Sociotechnical and PRISM domains were applied to identify workflow factors important to sustainable CCDS integration.
Results: Participants valued fall prevention and described similar approaches. Available resources differed between rural and urban locations. Participants wanted evidence-based guidance integrated into workflows to bridge skills gaps.
Discussion: Sites described similar clinical approaches with differences in resource availability. This implies that a single intervention would need to be flexible to environments with differing resources. Electronic Health Record's inherent ability to provide tailored CCDS is limited. However, CCDS middleware could integrate into different settings and increase evidence use.
Keywords: clinical decision support; evidence-based practice; falls; person centered care; prevention.