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Arkansas HCBS Provider Meeting Mary James, MA Brant Fries, PhD University of Michigan/interRAI Little Rock, Arkansas August 8, 2013
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
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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
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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
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Applications of interRAI Data
ASSESSMENT
Care Planning
Screening Quality
Case-MixPolicy
interRAI HC and interRAI ID
HC121 Items
ID 123
Items
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
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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
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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
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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
home!
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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
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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
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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
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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
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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)
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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.?
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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
