Arkansas HCBS Provider Meeting

transcript

Arkansas HCBS Provider Meeting Mary James, MABrant Fries, PhD

University of Michigan/interRAILittle Rock, Arkansas

August 8, 2013

UM Agenda

Review philosophy, structure, process behind interRAI assessment systems

Summarize ARLOC algorithm development process

Examine ARLOC structure Address other issues of concern

www.interrai.org©interRAI 2012 – Do not duplicate or distribute 3

Why are interRAI Assessments Different?

• Developed by international panel of experts on assessment and health services research, along with subject matter experts for given tool

• Carefully tested psychometric properties• Assessment drives decision-making at all levels,

from clinical to policy• Collect data once, use many ways

• Compatible systems across health care sectors

interRAI “Suite”• Wellness• Community Health • Home Care• LTC Facility• Post-acute Care• Palliative Care• Pediatric• Pediatric ID, MH

• Acute Care• Inpatient Mental Health

• Forensic supplement• Correctional Facilities• Community Mental Health• Developmental/Intellectual

Disabilities

• Self-Report Quality of Life

Applications of interRAI Data

ASSESSMENT

Care Planning

Screening Quality

Case-MixPolicy

interRAI HC and interRAI ID

HC121 Items

ID 123

69 Other Shared Items

128 Core Items

441 Items Total

interRAI HC and interRAI CMH

HC151 Items

CMH238 Items

57 Other Shared Items

110 Core Items

556 Items Total

Key Elements of interRAI Tools• Assessment, not only self-report• use multiple sources of information

• Full definitions, time delimiters, examples, exclusions

• Cover all relevant domains• individuals’ strengths and weaknesses• tradeoff of breadth and length

• Training manuals available

Design of Data Collection Form• “Domains”• Each domain has specific “items”• “Items” ARE NOT “questions”• Items identify specific information to be gathered• Interview with person only one possible information

source; others include:• Direct observations• Staff• Family/friends• Records

Sources of Information• Engage person whenever possible • Use conversation AND observation• If others present, ask for private time with

person in quiet spot • Corroborate information from person with key

supports, records• Critical thinking: don’t leave your brain at

Item ConstructionEach item has four components:

Intent: Why information is soughtDefinition: What exactly is to be recordedProcess: How to collect information – strategy/approachesCoding: How to record

Item “Rules” to Keep in Mind• Most response choices consistent:• No• Yes• Activity did not occur

• Some response choices are unique• Timeframes matter• e.g., “within last three (3) days”

• Some items to be asked directly of person

Cognitive Performance ScaleCPS combines information on memory impairment, level of consciousness, and executive function, with scores ranging from 0 (intact) to 6 (very severe impairment). The CPS has been shown to be highly correlated with the MMSE in a number of validation studies

Instrumental Activities of Daily Living (IADLs)

Intent: Record areas of function commonly associated with independent living

Process: Ask person about each area over last 3 days

Definitions: Shopping, transportation, housework, using phone, managing medications, managing money, meal prep

IADL Coding0 Independent — no help, set up, or supervision1 Setup help only2 Supervision — oversight/cuing3 Limited Assistance — help on some occasions4 Extensive assistance — help throughout task, but performs

50% or more of tasks on own5 Maximal assistance — help throughout task, performs less

than 50% of task on own6 Total dependence — full performance of activity during entire

period by other8 Activity did not occur — during entire period (do not use this

code in scoring capacity)

ADL Definitions• ADL Self-performance: measures what

person actually did, or was not able to do, within each ADL category

• Last 3 days• Measures performance, NOT capacity• Example: Locomotion • What did person actually do? Walk around house,

perform any type of in-house tasks, etc.?

ADL CodingCoding: actual level of involvement in self care0- Independent1- Set-up help only2- Supervision: oversight, encouragement, or cueing provided 3 or more

times during the period3- Limited assistance: person highly involved in activity; received physical

help in guided maneuvering of limbs or other non-weight bearing assistance

4- Extensive assistance: person performed part of activity on own--greater than 50%; weight bearing assistance

5- Maximal assistance: person involved and completed less than 50% of subtasks on own, weight bearing assistance

6- Total dependence: full performance of activity by another8- Activity did not occur: ADL activity was not performed by person or

others (regardless of ability)

ARLOC Algorithm Design

Cross-walk policy to items on iHC Confer with DHS staff; modify as needed Run ARLOC on test cases; OLTC staff

independent 703 review; compare outcomes Modify as needed Run in real-time with 100% OLTC review Modify as needed Adopt for ongoing use

Arkansas HCBS Provider Meeting

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