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OASAC – Presentation of Critical Event Reports of Falls
November 19, 2018
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Reporting of Critical Events
• Federal CMS requires states that operate a 1915 (c) Medicaid Waiver to provide assurances, including assuring the health, welfare and safety of Waiver participants.
• IDoA implemented an automated Critical Event Reporting Application (CERA) in July, 2017 as required by CMS.
• States have the flexibility to define the critical events that must be reported, however; all states must have a system for reporting abuse, neglect, exploitation, and unanticipated deaths.
• IDoA included falls in its definition of reportable critical events due to the poor outcomes associated with falls in the elderly population.
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Why include falls in the definition of reportable critical event types?
➢According to the U.S. Centers for Disease Control and Prevention:
• One in four Americans aged 65 plus falls each year.
• Every 11 seconds an older adult is treated in an emergency room for a fall, and every 19 minutes an older adult dies from a fall.
➢In 2014, the total cost of all fall injuries was $31 billion.
➢Falls reduce Seniors’ ability of living independently.
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Fall Related Event Data – 7/12/17 – 10/17/18
• IDoA has received 43,526 reports across all event types, totaling to 50,790 reportable critical incidents (by definition.)
• Of the 50,790 critical incident reports, 23,055 were related to distinct participants.
• Of the 50,790 reports, 4,728 reports were for falls without injury and 3,533 reports were for falls with injury.
• Of the 8,261 reports of falls, 5,424 were related to distinct participants.
• 15% of falls were associated with an Emergency Department (ED) visit
• 16% of falls were associated with an Unanticipated Hospitalization (UH)
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Breakdown of Falls Information
11%
12%
4%
73%
Falls with Emergency Departmentonly
Falls with UnanticipatedHospitalization only
Falls with both
Falls with neither
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Breakdown of Critical Incidents(Overlap occurs between incident types)
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Unanticipated Hospitalization
Emergency Department Visit
Fall without Injury Fall with Injury
Other
Unanticipated Death
Nursing Facility Placement
Anticipated Death
Special Circumstances
Serious Injury
Medication Error
Criminal Act/Law Enforcement Involvement
Property DamageMissing Person
Other
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Reported falls by PSA
631
317
494
409
723
838
832
207
1,564
189
634
732
691
5,835
5,389
2,858
1,393
2,075
4,523
2,952
724
5,309
895
2,584
4,929
3,063
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
13
12
11
10
09
08
07
06
05
04
03
02
01
Falls All other events
This chart shows the percentage of falls out of the total event reports.
For example, in PSA 09, 25% of the reports were related to a fall.
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Number of falls per participant7/12/17 – 10/17/18
• Of the CCP participants who reported a fall…• 4,006 or 73.86% experienced one fall
• 837 or 15.43% experienced two falls
• 301 or 5.55% experienced three falls
• 113 or 2.08% experienced four falls
• 167 or 3.08% experience 5+ falls
• One CCP participant reported as many as 40 falls
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74%
15%
6%
2%
3%
Distinct Participants by Number of Falls
1 Fall - 4,006
2 Falls - 837
3 Falls - 301
4 Falls - 113
5+ Falls - 167
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Out of the 5,424 distinct participants with falls
2,6442,453
327Participant had a fall without injuryand later had at least one fall thatresulted in an injury
Participant only had falls with noinjuries
Participant had a fall with an injuryand later had at least one fall that didnot result in an injury
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Characteristics of CCP participants that experienced a fall with/without injury• Top impairments for CCP participants that have experienced a fall:
1) Arthritis – 4,221
2) High blood pressure – 3,394
3) Heart related condition – 2,985
4) Gastrointestinal 2,525
5) Respiratory/lung – 2,516
6) Bladder/Bower issues – 2,176
7) Hearing impairment – 1,729
8) Visual impairment – 1,672
9) Cancer – 1,254
10) Kidney problems – 1,204
11) Uses walker/cane – 1,193
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Number of impairments for CCP participants that have experienced a fall
2% 2%
4%
7%
11%
13%
17%
44%
1 - 108
2 - 81
3 - 225
4 - 385
5 - 598
6 - 730
7 - 928
8 - 2,369
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Age of CCP participants that have experienced a fall
7.0%
14.9%
17.9%19.2%
18.2%
13.1%
7.1%
2.2% 0.4%
8.1%
13.7%
16.4% 16.9% 17.2%
14.5%
9.3%
3.3%0.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100+
Age of Participant
Total CCP Participants* Clients with Falls
*Participants that received a service within the last 6 months – 73,563 13
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DON scores for CCP participants that have experienced a fall
27.6%
31.2%
23.3%
11.9%
5.1%1.0% 0.1% 0.0%
23.8%
32.7%
23.5%
13.2%
5.3%1.4% 0.1% 0.1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
29-38 39-48 49-58 59-68 69-78 79-88 89-98 99-108
DON Score of Participants
Total CCP Population Clients with Fall
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Gender
Total CCP Population
28%
72%
Male
Female
Clients with Falls
25%
75%
Count of ClientID
Male
Female
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Race/Ethnicity
Total CCP Population
47%
36%
0% 7%
7%
3%White
Black
American Indian,Alaskan Native
Hispanic
Asian or PacificIslander
Other
Clients with Falls
84%
10%
0% 2%3% 1%
White
Black
American Indian,Alaskan Native
Hispanic
Asian or PacificIslander
Other
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Marital Status
Total CCP Population
23%
19%
3%10%
44%
1%
Married
Divorced
Separated
Never Married
Widowed
Other
Clients with Falls
17%
23%
2%8%
49%
1%
Married
Divorced
Separated
Never Married
Widowed
Other
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Living Status
Total CCP Population
55%
18%
17%
5%1% 3% 1% Alone
With Spouse
With Children
With OtherRelatives
With Non-Relative
With Spouse andChildren
Other
Clients with Falls
64%14%
14%
4%
2% 1% 1% Alone
With Spouse
With Children
With OtherRelatives
With Non-Relative
With Spouse andChildren
Other
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Core services for CCP participants that have experienced a fallTotal CCP Population
1% 0%
5%
53%
2%
1%
38%
0% ADS
ADSEHRS
EHRS
HMKR
HMKRADS
HMKRADSEHRS
HMKREHRS
No Core Services(Demo Only)
Clients with Falls
1% 1%3%
24%
1%
1%
52%
17%
ADS
ADSEHRS
EHRS
HMKR
HMKRADS
HMKRADSEHRS
HMKREHRS
No Core Services (Inlast 6 months)
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Risk Mitigation Strategies
• Federal CMS requires states that operate a Medicaid HCBS Waiver to mitigate risk to prevent a future occurrence of a critical event.
• IDoA requires the Care Coordination Units (CCUs) to follow up with CCP participants that have experienced a fall. Documentation of the follow up must entered into the Critical Event Reporting Application (CERA).
• Follow up by the CCU can occur via a phone call or face to face visit with the participant. Care coordinators are encouraged to link participants to evidence based programs, e.g. Matter of Balance,
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Collaboration with Univ. of IL. and other partners• IDoA is collaborating with Dr. Jake Sosnoff at the University of Illinois,
Champaign to ………(please insert description)
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Next steps - Discussion
• Monthly quality webinars
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