CHP
Conduit Health Partners
Fall Risk Screening
Telephonic Fall Prevention Assessment
Live Routing
Interventions triggered: 0
Fall History & Circumstances
Module A · 5 Questions
Patient Identification
These fields populate the PDF header, email subject, and results summary. Required before sending to client.
What we’re trying to learn: Has this person been falling, how often, how badly, and what were the circumstances? This is the most important module — fall history is the single strongest predictor of future falls.
A1
Have you fallen in the past 12 months?
A2
How many times have you fallen in the past 12 months?
A3
Did any of those falls result in an injury — a bruise, cut, fracture, or head injury?
A4
Can you tell me about the most recent fall — what were you doing, and where did it happen?
Flag if fall occurred in: bathroom, on stairs, at night, rushing to the toilet, getting out of bed or chair, or outside on uneven ground.
Flag location hazards:
A5
After your most recent fall, were you able to get up on your own?
Module A — Routing Logic
A1 = Yes→Continue full assessment, flag for NP assessment consideration
A2 = 2+ falls→Auto-trigger NP Home Assessment
A3 = Yes (injury)→Auto-trigger NP Home Assessment
A5 = No, needed help→NP Home Assessment + Home Care Aide evaluation
A4 location flags→Flag for home modification assessment
Mobility & Strength
Module B · 6 Questions · STEADI-adapted
These questions are adapted from the STEADI Stay Independent questionnaire. They’re the closest we can get to screening for gait, balance, and lower extremity strength over the phone.
B1
Do you feel unsteady when you are walking?
B2
Do you steady yourself by holding onto furniture or walls when walking at home?
B3
Do you need to push with your hands to stand up from a chair?
B4
Do you have trouble stepping up onto a curb or a single step?
B5
Have you been told by a doctor or therapist to use a cane or walker?
B5a
Do you use it?
B6
Are you worried about falling?
B6a
Does that worry keep you from doing things you’d like to do?
Module B — Routing Logic
3+ Yes in B1–B4→Trigger PT Home Visit
B5 = Yes AND B5a = No→PT Home Visit (device training)
B6a = Yes (fear limiting activity)→PT Home Visit + community exercise referral
2+ Yes in B AND A1 = Yes→NP Home Assessment (if not already triggered)
Medications
Module C · 5 Questions · STOPPFall Screening
We can’t do a proper medication review over the phone, but we can screen for major red flags. The goal is to identify people likely on fall-risk-increasing drugs (FRIDs) so we can route them to someone who can apply the full STOPPFall criteria (14 drug classes including sedatives, antidepressants, antipsychotics, opioids, diuretics, alpha-blockers, OAB medications).
C1
Do you take any medicines that sometimes make you feel lightheaded or dizzy?
C2
Do you take any medicines that make you feel more tired than usual?
C3
Do you take any medicine to help you sleep?
C4
Do you take any medicine for your mood, such as for anxiety or depression?
C5
How many different prescription medications do you take every day?
medications/day
Module C — Routing Logic
C1 or C2 = Yes→NP Home Assessment (medication review)
C3 AND C4 both Yes→NP Home Assessment
C5 ≥ 8 medications→NP Home Assessment (polypharmacy)
Home Environment
Module D · 5 Questions
These questions try to surface the most common environmental hazards from a phone call. We can’t see the home, but people are usually aware of the big stuff — rugs, grab bars, lighting, stairs. The OT visit and home modification service will do the real assessment; this just tells us whether to send them.
D1
Do you have throw rugs, loose cords, or clutter on your floors that you sometimes have to step over or around?
D2
Is the lighting in your home dim, especially in hallways, stairs, or the bathroom at night?
D3
Do you have grab bars in your bathroom — by the toilet and in the shower or tub?
D4
Do you have stairs in your home that you use regularly?
D4a
Do they have handrails on both sides?
D5
Have you had any falls inside your home?
Location
Where in the home did the fall occur?
Module D — Routing Logic
D1 or D2 = Yes→OT Home Visit (hazard assessment)
D3 = No or One→Home Modification Service
D4a = No (no handrails)→Home Modification Service
D5 = Yes + any D flag→OT Home Visit + Home Modification Service
3+ flags in Module D→Bundle OT + Home Modification
Daily Function & Support
Module E · 4 Questions · SDoH Screening
This module screens for functional decline and social determinants. It tells us whether someone needs hands-on help at home, whether they’re eating adequately, and whether they’re socially isolated — all of which affect fall risk and our ability to deliver interventions.
E1
Do you have difficulty with any of these activities?
E2
Do you live alone?
E3
Is there someone who checks in on you regularly — a family member, friend, or neighbor?
E4
In the past 12 months, have you had difficulty getting enough food or the right kinds of food?
Module E — Routing Logic
E1 bathing/dressing = Yes→Home Care Aide evaluation
E1 meals = Yes or E4 = Yes→Meals on Wheels / nutritional support
E1 transport = Yes→Transportation Service
E1 medications = Yes→NP Home Assessment
E2 = Yes AND E3 = No→High social isolation risk — prioritize all interventions
3+ Yes in E1→NP Home Assessment (broad functional decline)
Sensory & Other Risk Factors
Module F · 6 Questions
This catches remaining risk factors the other modules don’t cover: vision, continence, neuropathy, and cognition. These often get missed in a phone screen — urinary urgency and nocturia are big contributors, and neuropathy is common in the diabetic population that makes up a large share of subscribers.
F1
When was your last eye exam?
F2
Do you have trouble seeing, even with your glasses on?
F3
Do you often have to rush to get to the toilet?
F4
Do you frequently get up at night to use the bathroom?
F4a
How many times per night?
times per night
F5
Have you or anyone in your family noticed changes in your memory or thinking in the past year?
F6
Have you lost some feeling in your feet?
Module F — Routing Logic
F1 > 2yr or Don’t remember, or F2 = Yes→Vision Referral in care plan
F3 = Yes or F4a ≥ 3/night→NP Home Assessment (continence eval)
F5 = Yes→NP Home Assessment (cognitive screen)
F6 = Yes→NP Home Assessment (neuropathy/footwear)
Intervention Routing Summary
Overall Risk Indicator
Low RiskModerateHigh Risk
0
intervention triggers across all modules
Additional Clinical Notes
Send Results to Client
Subject line will include urgency tier so client Outlook rules can auto-route. Save PDF first, then attach it to the Outlook window that opens.