eSTEPS: EHR Exercise Prompts Modestly Reduces Falls in Older Primary Care Patients

An electronic health record (EHR)-integrated clinical decision support tool promoting tailored exercise modestly reduced falls and fall-related injuries among older primary care patients at increased fall risk, according to results of the eSTEPS cluster randomized clinical trial published in JAMA Network Open.

The investigators noted that although exercise reduces fall risk, its implementation in primary care remains limited. Their tool, Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS), was embedded in the Epic EHR as a noninterruptive care-gap alert linked to an order set with tailored strength and balance exercise recommendations. Clinicians could also refer patients to physical therapy, and patient-facing materials included handouts, a website, and an app.

Practices within the Mass General Brigham health system were randomized in matched pairs to the intervention or usual care, and 22 practices with 11,945 patients were analyzed. Patients were aged 65 years or older (mean, 77 years) and had screened positive for fall risk; follow-up ranged from 12 to 23 months. In adjusted analyses, the rate of patients with 1 or more falls identified by ICD-10 codes, the primary outcome, was 19.3 per 100 patient-years with the intervention vs 21.2 with usual care (rate ratio, 0.91; 95% CI, 0.88-0.95).

The rate of patients with fall-related injuries, a secondary outcome, was 15.7 vs 16.7 per 100 patient-years, and self-reported falls or fall-related injuries were also significantly reduced. Mortality did not differ significantly (rate ratio, 1.06; 95% CI, 0.89-1.27), and safety monitoring found no intervention-related serious adverse events. In unadjusted analyses, only self-reported falls differed significantly; the investigators said the difference from the adjusted results likely reflected baseline imbalances between groups. Clinicians issued eSTEPS exercise prescriptions for 22.1% of intervention patients, and uptake varied substantially across practices.

Limitations noted by the investigators included reliance on EHR diagnostic codes, which may have underestimated falls; a single health system and EHR platform, which may limit generalizability; and no data on patients’ adherence to the prescribed exercises. The authors concluded that the results suggest support for scalable fall prevention integrated into primary care workflows.

Source: Latham NK, Hommel E, Kiesman M, et al. Clinical decision support for fall prevention in primary care: the eSTEPS cluster randomized clinical trial. JAMA Netw Open. 2026;9(10):e2639240. doi:10.1001/jamanetworkopen.2026.39240