911 and EMS data enable the state to monitor the emergency services required following a fall, although this data is not currently centralized. Aging Services Access Points (ASAPs) collect data on falls, fall risk, and other indicators that are related to fall risk. Stored in the Senior Information Management System (SIMS), this data is from assessments of older adults receiving select ASAP services. Massachusetts hospitals voluntarily and publicly report patient falls and falls with injury data on the quality and safety website PatientCareLink, at . Patient falls and related injury are reported using the Nursing Quality Forum endorsed Nurse Sensitive Care Measure 3 and patient falls with injury are reported using the Nursing Quality Forum endorsed Nurse Sensitive Care Measure 4. Falls and injuries that are Hospital Acquired Conditions (HAC) measures are reported by CMS on the Hospital Compare website. CMS calculates the HAC measure from the claims hospitals submit for Medicare beneficiaries enrolled in the traditional (FFS) Medicare. These measures are expected to be removed from the Hospital Compare site in late 2013. Figure 3: Fall Prevention Data Sources and Measurements Data Measurement Data Source Demographics (e.g., age, sex, race, city/town) # and rate of fatal and/or nonfatal fall injuries # of 911 emergency transports for falls # of serious fall events in health care facilities Severity of Injury Prevalence of falls Risk/ protective factors Circumstance information Medical charges & costs of treatment City of injury incident Nature of Injury (e.g., hip fx) # of seniors applying for; # receiving, services Registry of Vital Records and Statistics limited limited Medical Examiner Records limited Acute Care Hospital Claims: Inpatient, Observation Stay, Emergency Department limited limited limited limited Insurance Claims Databases: Medicare, Medicaid, Commercial limited limited MA Trauma Registry Behavioral Risk Factor Surveillance limited WISQARS, CDC Cost Module* MA Ambulance Trip Reporting System 911 Data Calls Serious Incident Reporting System: Hospitals, Ambulatory Service
Hospitals: The Joint Commission, the organization that gives hospital accreditation, provides standards for patient safety including falls assessment and reduction. Failure by hospitals to implement these standards could jeopardize accreditation. Figure 5 summarizes the regulations and standards for falls prevention in Skilled Nursing Facilities, Home Health Agencies, Hospitals, and the Ambulatory Care Environment. The figure shows the absence of regulatory mechanisms or standards In the Ambulatory Care/Outpatient setting. Figure 5: Regulations, Policies, Tools and Standards Skilled Nursing Facilities Home Health Hospitals Ambulatory Care Risk Assessments Are included in the MDS (Minimum Data Set) assessment and as part of a comprehensive assessment of each resident. Best Practice to provide a formal multi-factor Falls Risk Assessment for all patients over 65 years old included in OASIS (Outcome and Assessment Information Set) Standards by The Joint Commission for hospital to assess patient fall risk, and implement falls reduction intervention. Voluntary; Existing clinical guidelines from the American Geriatric Society and others. Falls Performance Monitoring CMS: If resident is assessed as at risk for falls, there must be a care plan that addresses this risk. Skilled nursing homes are required to resident falls to DPH. CMS recommends Falls Prevention Interventions are implemented as part of the physician- ordered Plan of Care MA hospitals voluntarily report and publicly report patient falls and falls with injury on the quality and safety website PatientCareLink, at www.patientcarelink.org Hospitals are expected to report falls that are Serious Reportable Events (SREs) as defined by the National Quality Forum (NQF) to the MA DPH. Voluntary Websites for Consumers Nursing Home Compare: includes falls incidence Home Health Compare: quality and performance measures for home health agencies Hospital Compare: Includes Hospital Acquired Conditions of falls and injuries PatientCareLink: voluntary posting of performance measures None Medicare Certification/ Participation DPH may cite a facility for falls under Accidents/Supervisions during an annual survey or as part of a complaint, and they may assess civil monetary penalties. CMS recommends a formal multi-factor Falls Risk Assessment for all patients over 65 years old. This data is reported to the state using OASIS tool as a condition for Medicare participation. For Hospital Acquired Conditions (HAC) of Falls and Trauma (Includes: fracture, dislocation, intracranial injury, crushing injury, burn, electric shock); hospitals cannot receive additional payment from Medicare or charge Medicare patients for treating these conditions. None Staff Training Voluntary Voluntary Most hospitals require falls Voluntary