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Arkansas HCBS Provider Meeting
Mary James, MA
Brant Fries, PhD
University of Michigan/interRAI
Little Rock, Arkansas
August 8, 2013
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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
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interRAI HC and interRAI ID
HC121 Items
ID 123
Items
69 Other Shared Items
128 Core Items
441 Items Total
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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 Construction
Each item has four components:Intent: Why information is sought
Definition: What exactly is to be recorded
Process: How to collect information –
strategy/approaches
Coding: 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 supervision
1 Setup help only
2 Supervision — oversight/cuing
3 Limited Assistance — help on some occasions
4 Extensive assistance — help throughout task, but performs 50% or more of tasks on own
5 Maximal assistance — help throughout task, performs less than 50% of task on own
6 Total dependence — full performance of activity during entire period by other
8 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)
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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
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