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  • Measure Summary
  • NQMC:010355
  • Jul 2013
  • NQF-Endorsed Measure

Geriatrics: percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months.

American Geriatrics Society (AGS), American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Geriatrics: performance measurement set. Washington (DC): National Committee for Quality Assurance (NCQA); 2013 Jul. 40 p. [11 references]

This is the current release of the measure.

This measure updates a previous version: American Geriatrics Society, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Geriatrics physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2009 Jul. 40 p.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months.

Rationale

Interventions to prevent future falls should be documented for the patient with 2 or more falls or injurious falls.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

The U.S. Preventive Services Task Force (USPSTF) (2012) recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.

The American Geriatrics Society (AGS) 2010 clinical practice guidelines (AGS & British Geriatrics Society [BGS], 2010) recommend:

Multifactorial/Multicomponent Interventions to Address Identified Risk(s) and Prevent Falls

  1. A strategy to reduce the risk of falls should include multifactorial assessment of known fall risk factors and management of the risk factors identified.
  2. The components most commonly included in efficacious interventions were:
    1. Adaptation or modification of home environment
    2. Withdrawal or minimization of psychoactive medications
    3. Withdrawal or minimization of other medications
    4. Management of postural hypotension
    5. Management of foot problems and footwear
    6. Exercise, particularly balance, strength, and gait training
  3. All older adults who are at risk of falling should be offered an exercise program incorporating balance, gait, and strength training. Flexibility and endurance training should also be offered, but not as sole components of the program.
  4. Multifactorial/multicomponent intervention should include an education component complementing and addressing issues specific to the intervention being provided, tailored to individual cognitive function and language.
  5. The health professional or team conducting the fall risk assessment should directly implement the interventions or should assure that the interventions are carried out by other qualified healthcare professionals.

Evidence for Rationale

American Geriatrics Society (AGS), American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Geriatrics: performance measurement set. Washington (DC): National Committee for Quality Assurance (NCQA); 2013 Jul. 40 p. [11 references]

American Geriatrics Society (AGS), British Geriatrics Society (BGS). AGS/BGS clinical practice guideline: prevention of falls in older persons. New York (NY): American Geriatrics Society (AGS); 2010. various p. [116 references]

U.S. Preventive Services Task Force (USPSTF). Final recommendation statement: falls prevention in older adults: counseling and preventive medication. [internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2012 May.  [29 references]

Primary Health Components

Geriatrics; falls; plan of care

Denominator Description

All patients aged 65 years and older with a history of falls (history of falls is defined as 2 or more falls in the past year or any fall with injury in the past year) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients with a plan of care for falls documented within 12 months (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Assisted Living Facilities

Home Care

Hospital Outpatient

Rehabilitation Centers

Skilled Nursing Facilities/Nursing Homes

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 65 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Safety

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 65 years and older with a history of falls (history of falls is defined as 2 or more falls in the past year or any fall with injury in the past year)

Note: Refer to the original measure documentation for administrative codes.

Exclusions
Documentation of medical reason(s) why a plan of care is not documented

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients with a plan of care for falls documented within 12 months

Note:

Plan of care must include:

  • Consideration of Vitamin D Supplementation: Medical record must include documentation that vitamin D supplementation was advised or considered OR documentation that patient was referred to his/her physician for vitamin D supplementation advice

AND

  • Balance, Strength, and Gait Training: Medical record must include documentation that balance, strength, and gait training/instructions were provided OR referral to an exercise program, which includes at least one of the three components: balance, strength, or gait OR referral to physical therapy

Refer to the original measure documentation for administrative codes.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #8: plan of care for falls.

Measure Collection Name

Geriatrics Performance Measurement Set

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

American Geriatrics Society - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Original Geriatrics Work Group*: Caroline Blaum, MD (Co-chair); Carol M. Mangione, MD (Co-chair); Chris Alexander, III, MD, FACP; Ronald Bangasser, MD; Patricia P. Barry, MD, MPH; Frederick W. Burgess, MD, PhD; Gary S. Clark, MD, MMM, CPE; Eric Coleman, MD, MPH; Stephen R. Connor, PhD; Gail A. Cooney, MD; Roger Dmochowski, MD; Catherine DuBeau, MD; Joyce Dubow; Mary Fermazin, MD, MPA; Sanford I. Finkel, MD; Terry Fulmer, PhD; Peter Hollmann, MD; David P. John, MD; Peter Johnstone, MD, FACR; Flora Lum, MD; Diane E. Meier, MD; Alvin "Woody" H. Moss, MD; Jaya Rao, MD, MHS; Sam J. W. Romeo, MD, MBA; David J. Satin, MD; Gregory B. Seymann, MD; Knight Steel, MD; Eric Tangalos, MD; Joan M. Teno, MD, MS; David J. Thurman, MD, MPH; Mary Tinetti, MD; Laura Tosi, MD; Gregg Warshaw, MD; Neil S. Wenger, MD

American Geriatrics Society: Jill Epstein

National Committee for Quality Assurance: Erin R. Giovannetti, PhD; Min Gayles Kim, MPH; Phil Renner, MBA

American Medical Association: Karen Kmetik, PhD; Katherin Ast, MSW, LCSW; Heidi Bossley, MSN, MBA; Joanne Schwartzberg, MD; Patricia Sokol, RN, JD

Facilitators: Timothy F. Kresowik, MD; Rebecca A. Kresowik

*The composition and affiliations of the work group members are listed as originally convened in 2007 and are not up to date.

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Endorser

National Quality Forum

NQF Number

0101

Date of Endorsement

2014 Apr 1

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jul

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: American Geriatrics Society, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Geriatrics physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2009 Jul. 40 p.

Source(s)

American Geriatrics Society (AGS), American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® (PCPI), National Committee for Quality Assurance (NCQA). Geriatrics: performance measurement set. Washington (DC): National Committee for Quality Assurance (NCQA); 2013 Jul. 40 p. [11 references]

Measure Availability

Source not available electronically.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 13, 2008. The information was verified by the measure developer on September 30, 2008.

This NQMC summary was edited by ECRI Institute on September 28, 2009.

This NQMC summary was retrofitted into the new template on June 3, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

Stewardship for this measure was transferred from the PCPI to the NCQA. NCQA informed NQMC that this measure was updated. This NQMC summary was updated by ECRI Institute on October 12, 2015. The information was verified by the measure developer on November 18, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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