Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E fAll RISk MANAGEMENT falls among older adults are a growing national concern because of the financial and societal costs associated with falls and the expanding body of evidence that falls can be reduced. 1,2 The Fall Risk Management measure assesses whether adults over 65 years of age who are at risk of falling discussed their problem with their practitioner and received an appropriate intervention, if necessary. • Among adults 65 and older, falls are the leading cause of injury and death—each year one in every three adults experiences a fall. 2 falls are also the most common cause of nonfatal injuries and hospital admissions for trauma. 3 The chances of falling and of being seriously injured in a fall increase with age. 2,3 • Most falls result in fractures. 3,4 the Case for Improvement • Direct medical costs of falls total more than $19.3 billion—$349 million for fatal falls and $19 billion for nonfatal fall injuries. 6,7 This translates to $26 billion in dollars. 7 Hospitalizations and visits to the emergency department make up more than 80 percent of the costs. 7 • In 2009, 2.2 million adults were treated in emergency departments for nonfatal fall injuries; more than 581,000 of these patients were hospitalized. 5 105 • Many older adults who fall develop a fear of falling that may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling. 3 HEdIs Measure definition The two components of this survey measure assess different facets of fall risk management. • The percentage of Medicare adults 75 years of age and older, or adults 65–74 years of age with balance or walking problems or a fall in the past 12 months, who were seen by a practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner. • The percentage of Medicare adults 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received fall risk intervention from their current practitioner. M E A S U R E S T A R G E T E D A T o l D E R A D U l T S
M E A S U R E S T A R G E T E D A T o l D E R A D U l T S results A discussion between provider and patient regarding falls identifies risk factors related to vision, muscle strength and reflexes— important information for developing an appropriate intervention plan. 2 yEAR 106 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E dIsCussIon CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 NA NA 32.8 31.1 NA 2009 NA NA 31.1 30.3 NA 2008 NA NA 31.3 30.7 NA 2007 NA NA 29.4 28.1 NA 2006 NA NA 27.5 26.9 NA yEAR ManagEMEnt CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 NA NA 60.1 55.3 NA 2009 NA NA 57.7 54.7 NA 2008 NA NA 57.8 54.6 NA 2007 NA NA 55.8 53.4 NA 2006 NA NA 56.0 54.2 NA
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2 This Report and the data containe
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4 N AT I o N A l C o M M I T T E E
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top 10 and bottom 10 states “loca
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16 this measure has shown steady ga
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24 HEDIS MEASURES of CARE about HEd
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C H R o N I C D I S E A S E M A N A
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Page 131 and 132: 130 APPENDIx 1: HEDIS EffECTIVENESS
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156 N AT I o N A l C o M M I T T E
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158 APPENDIx 8: PUblICly REPoRTING
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172 MEASURE N AT I o N A l C o M M
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174 APPENDIx 14b: VARIATIoN IN PlAN
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180 APPENDIx 16A: VARIATIoN IN PlAN
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182 APPENDIx 16b: VARIATIoN IN PlAN
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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