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2023 MIPS Improvement Activity IA_PSPA_21: Implementation of fall screening and assessment programs

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Activity Description

Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk).

Activity ID Activity Weighting Sub-Category Name
IA_PSPA_21 Medium Patient Safety & Practice Assessment

Objective & Validation Documentation

Objective: Improve identification of patients who are at risk of falling; then reduce their risk and improve their health outcome, independence, and satisfaction with care.

Validation Documentation: Documented implementation of fall screening and assessment programs. Include at least one of the following elements:
1) Implementation of a falls screening and assessment program – Documentation of newly implemented falls screening and assessment program that uses valid and reliable tools to identify patients at risk for falls and address modifiable risk factors (e.g., clinical decision support (CDS)/prompts in the electronic health record (EHR) that help manage the use of medications, such as benzodiazepines, that increase fall risk). The program population should be defined by the eligible clinicians (e.g., all patients over a certain age); OR
2) Implementation progress – Documentation of follow-up after falls screening and assessment with focus on improvement in risk factors. Documentation of follow-up may include: follow-up screening, notes or medication list demonstrating mitigation of the risk or other health record data demonstrating follow-up, etc.

Example(s)/Information: Implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (CDC STEADI) program for identification of falls risk and actions to take to mitigate falls. https://www.cdc.gov/steadi/about.html