In 2009 the Physician Quality Reporting Initiative included assessing for falls and creating plans to reduce falls. This research looking at claims data from 2012-2013 provides insight into clinical practice.

I am not always in agreement with how Centers for Medicare and Medicaid Services has proposed to improve care. I can see from history that reporting isn’t the same as actually implementing changes into practice.

Many in the medical world know that once an older adult falls, it is very highly likely that a another fall is probable. I can see from the below study that when an older adult is seen in the emergency room with injuries or complications from a fall, the care is only focused on the immediate situation and is not forward thinking to reduce additional injuries down the road due to another fall.

As I look at the numbers, only 3% of the patients received services from a physical therapist. I don’t believe that having a physical therapist in the emergency department after an injurious fall would provide much tangible benefit with regard to providing lasting procedures during that emergency visit. What I believe would be better would be to have the physical therapist educate and provide information on why outpatient services would be helpful, when to initiate the services and assist with locating an outpatient option for the patient. It would actually probably be cheaper to have the person performing the emergency room visit discharge be responsible for ensuring a referral to a physical therapist… and it might even be really helpful to have a clinical decision guideline within the electronic health record propose a follow-up with a physical therapist.

It is very surprising to me that this study looked at data after PRQI was implemented when PQRI had a targeted measure focused on assessing for falls and creating a plan of care for falls. There was a big disconnect in ensuring that a future fall could be substantially reduced.

You’ll find the abstract to the recent study below.

Association Between Physical Therapy in the Emergency Department and Emergency Department Revisits for Older Adult Fallers: A Nationally Representative Analysis.

Lesser A¹, Israni J¹, Kent T¹, Ko KJ¹.

Abstract

OBJECTIVES:

To determine whether providing physical therapy (PT) services in the emergency department (ED) improves outcomes for older adults who fall.

DESIGN:

We used Medicare claims data to examine differences in recurrent fall-related ED revisit rates of older adults who presented to the ED for a ground-level fall and whether they received PT services in the ED. Our logistic regression model controlled for age, sex, Medicaid eligibility, acute injury, and certain known chronic comorbidities associated with risk of falling.

SETTING:

We analyzed national 2012-13 Medicare claims data for individuals aged 65 and older.

PARTICIPANTS:

This was a claims-based analysis. We defined an index visit as any ED claim that included an International Classification of Diseases, Ninth Revision, Clinical Modification E-Code indicating a ground-level fall. Visits resulting in admission were excluded, as were claims associated with an individual who died during follow-up; 17,975 of the 560,277 claims for eligible outpatient index visits included revenue center codes for PT services.

MEASUREMENTS:

We calculated the proportion of index visits associated with a fall-related ED revisit within 30 and 60 days and assessed differences in these proportions between individuals who did and did not receive PT services in the ED.

RESULTS:

Receiving PT services in the ED during an index visit for a ground-level fall was associated with a significantly lower likelihood of a fall-related ED revisit within 30 days (odds ratio (OR)=0.655, p<.001) and 60 days (OR=0.684, p<.001).

CONCLUSION:

Expanding PT services in the ED may reduce future fall-related ED use of older adults. Additional analyses could assess characteristics of individuals receiving PT in the ED and follow-up PT use after discharge.

J Am Geriatr Soc. 2018 Aug 21. doi: 10.1111/jgs.15469. [Epub ahead of print]