Data Quality: Approaches Used to Support the Quality & Utility of the interRAI CHA and IAR for Client Care Please put your speaker phone on mute (*6) Do not put your phone on hold ! Your screen should show a Participants panel and a Chat panel If not, go into the panel menu by clicking the green tab Then click on the Participants icon to open the Participant box and the Chat icon to open the Chat box To ask a question during the WebEx, write it out in the Chat box and select “send to all participants”

Agenda Objectives Community Support Services Common Assessment Lessons Learned 2014/2015 HSP’s share their approaches for sustaining the interRAI Community Health Assessment (interRAI CHA) to support client care LHIN update related to activities for promoting the quality and utility of the interRAI CHA and IAR in CSS sector 2

Objectives Understand the relevance of how interRAI CHA, outputs and report information can build the foundation to support client care and inform care planning Create awareness of the Community Support Services Common Assessment Lessons Learned for 2014/2015 To provide an opportunity for HSP’s and LHINS to share their approaches for sustaining the interRAI CHA and IAR to support client care

What is the interRAI CHA? An electronic standardized comprehensive assessment Modular format Not all inclusive – “minimum” data set Data elements designed to be used for: –Care planning –Outcome measures based on clinical scales –Quality improvement using quality indicators interRAI Community Health Assessment (CHA) helps identify adults needing supports to prevent or stabilize early functional or health decline 4

Clinical Assessment Protocols Report 25 CAPs capture client needs/problems, and strengths under broad categories of Functional Performance, Cognition/Mental Health, Social Life and Clinical Issues 5 Care Planning: Putting it all together interRAI CHA & Supplements CAPs Outcome Scales interRAI CHA & Supplements Algorithms built into the assessment automatically generate reports which can help inform care planning Outcome Scales Report 8 outcome scales/measures capture client acuity and risk Care Planning

Benefits: Primary Purpose: Identifies individual needs, helps match these to existing services and identifies service gaps Informs client centred care and service plans Further facilitates communication among HSPs through common data standards Secondary Purpose: Enhances the quality of information by having a consistent approach to collection Provides aggregate data to inform organizational, regional and provincial-level planning and decision making that is consistent across the sector

Standardized Reports: HSP and LHIN Level

The Value of Data Quality Accurate interRAI CHA data will reflect: Accurate outputs and reports Evidence based decision making Accurate scores for risk management and quality improvement

InterRAI CHA Completion Review Generated CAPS & Outcome Scales Care / Service Planning Integrated Assessment Record InterRAI CHA Software & IAR Reports Data Quality Continuous Quality Improvement

Community Support Services Common Assessment Lessons Learned 2014/2015

Common Challenges 1. Sustaining the use of the interRAI CHA and /or interRAI Preliminary Screener ( interRAI PS) tools to support client care 2. Maintaining standards and data quality of the assessment information entered into the interRAI CHA and/or interRAI PS tools 3. Maintaining Reassessment Schedule for interRAI CHA and incorporating it into the daily workflow 4. Maintaining an understanding and usage of interRAI CHA outputs to support client outcomes 5. Maintaining technology in order to ensure data submission of the interRAI CHA and/or PS to the IAR and access to reports

Community Support Services Common Assessment Lessons Learned ChallengesLessons Learned Sustaining the use of the InterRAI Community Health Assessment (CHA ) and/ or InterRAI Preliminary Screener (PS) tools to support client care  Communication Plan  Supportive working environment  Ongoing Training  Champion/Mentor  Access to training resources  Engage in data quality improvement plans Maintaining the standards and data quality of the assessment information entered into the InterRAI (CHA) and /or InterRAI PS tools  Use of InterRAI CHA and /or InterRAI PS User’s Manuals  Use of the InterRAI Clinical Assessment Protocols(CAPS) Manual  Data Quality Toolkit  InterRAI CHA data Quality Audit Reviews  HSP Assessment software generated &  Standardized Clinical IAR Reports

Community Support Services Common Assessment Lessons Learned ChallengesLessons Learned Maintaining Reassessment Schedule for InterRAI CHA and incorporating it into the daily workflow  Follow Best Practice Guidelines  Complete InterRAI supplement(s) as triggered  Outcome scales to inform reassessment frequency Maintaining an understanding and usage of InterRAI CHA outputs to support client outcomes  Review CAP Triggers  Incorporate CAPS & Outcome Scales into care/service planning  Process for accessing and reviewing InterRAI CHA outputs, software generated and IAR reports Maintaining technology in order to ensure data submission of the interRAI CHA and /or InterRAI PS to the IAR and access to reports  InterRAI CHAs or PSs are uploaded to the IAR  HSPs address IAR Technical issues  HSPs maintain IAR User Accounts & Consent Management processes

LHIN Update Supporting the Quality and Utility of the interRAI CHA and IAR

Central LHIN Common Assessment and IAR Adoption Project Update 15 Karen Blackley, eHealth Program Manager Central LHIN

Central LHIN CA & IAR Adoption Project – CSS Updates 16 Common Assessment and IAR Working Group (co-chaired by LHIN and CSS HSP) Working Group continues to meet on a regular basis Developed a detailed work plan to support Common Assessment and IAR adoption IAR Trainer for the community sector has been hired by one of our HSPs support education and training for both the common assessments and the IAR has been hired Roll-out of the AIS (Assessment & Intelligence Systems) and first pre-test has been completed by our HSPs

Central LHIN CA & IAR Adoption Project – MH&A Updates 17 LHIN recently attended our MH&A Network meeting to review the OCAN and IAR Operational Reports Commitment for ongoing dialogue with the LHIN on items such as use of IAR in business processes, consent practices, uploading practices Look for opportunities for IAR Trainer to also support MH&A organizations with increase use of the IAR

Thank you Questions? Comments? Central Local Health Integration Network 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: or Fax:

Moving Towards Adoption Mike O’Connor Officer – Project Management Office – Enabling Technologies

“Assessment” of the Assessment Tools The evaluation has found that 3 recommendations are possible Quick Wins. This means that these 3 activities are thought as having the highest impact to the adoption of the tools while requiring relatively less resources than other activity areas. In other words, the system should be in a position to support advancement on these 3 initiatives at any moment. Upload all assessment information to the IAR Communicate clear direction / expectation on use of the tools All referrals need to reference a Screener or CHA / HC assessment provided that client consents to share information

Recommendations & Key considerations Action Area – LHIN-led initiatives requiring HSPs that have not yet implemented/adopted the tools/IAR to prepare and submit an adoption plan a requirement to upload all assessment information to the IAR; and a requirement to adopt as a condition to any additional funding allocation destined to the CSS / CCAC sectors. Key considerations -HSPs expect to find client assessment information in the IAR to incorporate in client care planning and avoid unnecessary reassessments -The “direction” needs to be inclusive of support mechanisms to assist agencies to complete the implementation and work towards adoption (anticipate ICT / training requirements) -Policy changes are highlighting the importance of adopting common assessment tools and practices and the IAR -Seek opportunities to support the HSP’s service planning QIP efforts by leveraging information derived from the tools / IAR -Establish adoption benchmarks 21

Recommendations & Key considerations Action Area – Standards and Collaboration This project was the first time where some HSPs were able to speak about their experiences. Some have outlined effective best practices and others shared important challenges. A mechanism is required to encourage service providers to collaborate on: Training – identifying requirements / targeting delivery Standards – client education and practices regarding consent Key considerations Establish a “forum” – a structured mechanism to foster dialogue on topics such as assessment best practices, training requirements, care reviews. It should aim to: -Support challenges resulting from staff turnover -Leverage technology to facilitate access to training/standards and support self- direct training -Build mentorship relationships -Engage the HSPs, Support (CCIM) and authority (LHIN) 22

Recommendations & Key considerations Action Area – Linkages to existing efforts Some adoption opportunities can be fostered by anchoring “changes” within the local health system’s practices. While they are not directly related to the implementation / adoption of the common assessment, these initiatives have the potential to improve the usage of the tools; the quality of the information and to improve the client’s experience in the system. -Build on existing efforts to formalize / centralize / make available a formal “assessor” where a protocol exists identifying the lead provider and role -Establish a standard for referring clients that have a certain AUA (screener) score (to the CCAC and to other HSPs) all the while ensuring that a referral is accompanied by an assessment (screener / CHA) accessible via the IAR Key considerations HSP capacity to perform CHA’s along with assessor’s consistency when administering the assessment has been identified as a risk to the adoption of the tool and to the validity of the assessment information in the IAR. The collaborative assessor role may require a pooling of resources which will require support from HSPs/LHIN. It also imparts the need for standardized training to ensure consistency in assessment practices. 23

Questions?

CSS HSPs Approaches for Supporting the Quality and Utility of the interRAI CHA

Approaches for Supporting the Quality and Utility of the interRAI CHA January 28, 2016 Sujata Ganguli, Executive Director Narain Motwani, Manager of Client Services St. Clair West Services for Seniors 26

27  St. Clair West Services for Seniors is a non-profit charitable organization which has been providing valuable, innovative, and caring support services since 1973 to older and/or disabled adults  We provide services to 2100 clients and participants. We employ 150+ staff, and annually benefit from the contribution of 35 placement students and over 250 volunteers. Who we are and what we do

28 We provide a range of services including:  Adult Day Services  Supportive Housing/Transitional Apartments  Case Management  Home Help/ Respite Care  Meals on Wheels  Transportation – Individual and Group  Elderly Person’s Centre and Community Development and Outreach Programs which include social dining, gardening, computer classes, community kitchens etc.  Right Place of Care ( TCLHIN precursor to Personal Support Services Regulatory Amendments & Policy Implementation) Who we are and what we do

29 In 2008, after receiving funding for Supportive Housing under Aging At Home, we piloted the tool for clients receiving Supportive Housing and Adult Day Services. The key reasons we went ahead in implementation of the tool were: Evidence-based decision support and means to measure impact Clinical Assessment Protocol (CAPs) triggers for care planning In , the interRAI CHA and interRAI PS tools were incorporated into our client information management software, along with the ability to share assessment information with other service providers through Integrated Assessment Record. Implementation of the interRAI CHA and interRAI Preliminary Screener

30  Assessors use CAPs and Outcome Measures for care planning and service planning each time they complete an assessment. They review three assessor reports regularly to understand clients’ conditions and effects of intervention.  Managers make use of HSP reports and IAR reports for program planning and understanding the needs of the client populations served. Implementation journey of the interRAI CHA and interRAI Preliminary Screener

31 We have been able to sustain the interRAI CHA and interRAI PS tools because the tools are championed by the agency leadership:  Management provides a positive supportive working environment for staff to ensure sustainability of the tools  A Manager with a high level of expertise in the tools is assigned to support assessors with any issues  Management has been innovative in the use of assessment information at the agency level 1: Sustaining the use of the interRAI CHA and Preliminary Screener tools to support client care

32 We have been able to sustain the interRAI CHA and interRAI PS tools because Preliminary Screener and interRAI CHA business processes have been developed:  Completing interRAI PS is part of intake process  Completing initial interRAI CHA within 10 business days of referral is part of program/department processes  Assessments are submitted to IAR regularly  Intake worker and care coordinators/assessors access IAR to view and determine the need for interRAI CHA 1: Sustaining the use of the interRAI CHA and Preliminary Screener tools to support client care

33 We have been able to sustain the interRAI CHA and interRAI PS tools because:  We listen to assessors’ feedback and change the process as needed  For clients with stable conditions, we changed the reassessment requirement from every 6 months to every 12 months  We allowed assessors to decide whether to use laptops or hard copy assessment forms, depending on their own comfort level and perception of the client/caregiver comfort level  CAPs and Outcome Measures are integral part of the care plan and service plan  Care plan format is designed in a way that guides the assessor and client/caregiver to address CAPS and outcomes 1: Sustaining the use of the interRAI CHA and Preliminary Screener tools to support client care

34  New assessors are provided full 3½-day interRAI CHA assessment coding and care planning training  Training is facilitated by experienced assessors who have received “train the trainer” training  To address staff turnover, we have build internal capacity to train assessors and trainers  Training covers the importance of data quality elements as per CCIM Data Quality Toolkit i.e. Accuracy, Timeliness, Comparability, Usability and Relevance as well as benefits of accurate data. 2: Maintaining standards and data quality of the assessment information entered into the interRAI CHA

35  Assessors have various means to ensure the accuracy of their coding  Assessors use interRAI CHA and CAPS manuals for reference  Assessors use the data quality toolkit quick guide to understand the intent of the question and access tips related to each element  Assessors review, self reflect, and discuss the responses and coding with their peers and supervisor in case the Outcomes and CAPs do not reflect their professional opinion with regard to the health status and service need of the client e.g. MAPLe score is low but client is very high need or MAPLe score is high for a low need client  To maintain assessor competency on an ongoing basis, the assessment team conducts a case study, completes interRAI CHA assessment jointly and compares coding among team members. 2: Maintaining standards and data quality of the assessment information entered into the interRAI CHA

36 The agency has put in place the following reassessment processes:  Reassessments are completed annually or when the health status of the client changes  Reassessments can be completed one month prior to or one month after the due date i.e. within three months spread over time for stable clients with chronic conditions  Reassessments for clients with acute conditions are completed within three months of initial assessment to determine if service needs have changed  Reassessment for Right Place of Care clients is conducted upon receipt of request from the client, caregiver or PSW for changes in the intensity and frequency of service  Functional supplements are completed when triggered 3: Maintaining reassessment schedule for interRAI CHA and incorporating it into the daily workflow

37 The agency has put in place the following reassessment processes (cont.):  Reassessment dates are entered by assessors in the assessment panel of the software  Assessors are responsible for generating lists of reassessments due in the next month and completing reassessments as required  Manager of Client Services reviews HSP report #3 to :  determine status of assessments completed or in progress by each assessor in a specific period of time  determine timeliness of assessment completion  understand the case load of each assessor and rebalance as needed 3: Maintaining reassessment schedule for interRAI CHA and incorporating it into the daily workflow

38  The client care plan format incorporates the CAPS and individual ADL and IADL capacity and difficulty, as well as the specific needs identified and prioritized by the client and assessor  The Outcome Measures are used to provide understanding of the overall health condition of an individual client and specific client populations e.g. different supportive housing sites, and are used to guide interventions  The Decision Algorithm for Supportive Housing(DASH) and Personal Support Decision Algorithm (PSDA) are two outcome measure-based scales that are used to guide equitable resource allocation  Client and HSP level reports are used to compare the outcome of interventions and client health status over the period of time 4: Maintaining an understanding and usage of interRAI CHA outputs to support client outcomes

39 IAR Data submission is the responsibility of the Manager of Client Services, who:  Uploads assessments to IAR on a regular schedule, and ensures that technical issues related to uploading of assessments are resolved as quickly as possible  Manages IAR User Accounts and ensures assessors are keeping accounts active  Contacts the CCIM support center if there are any changes in the static IP for submission and accessing assessment information on IAR  Responds to EMPI Data Steward notifications of potential client matches and conducts further investigations The IAR website is bookmarked in the browsers of all relevant staff for easy access. 5: Maintaining technology in order to ensure data submission of the interRAI CHA to the IAR and access to reports

40  The Manager of Client Services accesses, prints and reviews IAR reports and software-generated HSP reports, and assures that the IT capacity to do so is maintained.  The Manager of Client Services exports all interRAI CHA assessment information to spreadsheets and generates customized point-in-time or periodic reports which include:  analytics for a quick graphic view of Outcomes and CAPS in order to visualize the nature of the client population served and observe changes over time  specific data reports in response to requests by Directors and Managers for information for planning, decision support, funding requests, etc. 5: Maintaining technology in order to ensure data submission of the interRAI CHA to the IAR and access to reports

Reports Assessor Report #1Client's CAP's and Outcomes - Show only triggered CAP's and Outcome Measures for one client Assessor Report #2Client Progression Report - Show CAP's and Outcome Measures for one client over time Assessor Report #3Client Assessment Summary Report - Provide a summary of the client Organization (HSP) Report #1 Clinical Report- Understand acuity of an organization based on CAPs and outcome meansures on a particular day of all current assessments of all active clients Organization (HSP) Report #2 Clinical Report- Provide an overview of all active clients of the organization on their acuity at a point in time Organization (HSP) Report #3 Operational Report- Understanding Assessment Process for Organization

Example 1: Outcome Measures

Example 2: Clinical Assessment Protocols

Example 3: MAPLe and CHESS

St. Clair West Services for Seniors 2562 Eglinton Avenue West 2nd Floor, Suite 202 Toronto, ON M6M 1T4 Phone: Fax: Questions? Narain Motwani, MSW, RSW Manager of Client Services 45

Pam Murray Adult Day Program Supervisor

Who Are We: “CHATS offer a full range of in-home and community services that enable seniors to continue living in their own home” CHATS enhances the health, wellness and independence of more than 7,300 York Region and South Simcoe seniors and caregivers each year CHATS has just over 400 employees and approximately 500 volunteers

Common Challenges: Maintaining an understanding and usage of InterRAI CHA outputs to support client outcomes Maintaining Reassessment Schedule for interRAI CHA and incorporating it into the daily workflow Sustaining the use of the interRAI CHA tool to support client care

Maintaining an Understanding and Usage of interRAI CHA Outputs to Support Client Outcomes All Adult Day Program (ADP) clients are referred from CCAC and we receive a RAI-HC with their referral To prevent the client from being “over-assessed” the ADP uses the Clinical Assessment Protocols (CAPs) Summary triggered by the RAI-HC to create a care plan for the client The initial care plan is developed by the ADP supervisor Care plans are reviewed quarterly by the Recreation staff Changes to the interventions are made according to what they have observed since client has been in program

Examples of How We Use the CAPS to Build the Care Plan in the ADP CAP TriggeredCare plan GoalsCare plan interventions Physical activity promotion To increase hours of exercise and physical activity. Prevent loss of independent function. Client will be encouraged to participate in the 30 minute Sit Fit and 15 minute Stretch program offered each day she attends the adult day program. Falls 2- high risk for falls Reduce risk and frequency of falls Client will be identified as a falls risk by wearing a blue name tag upon entering the ADP. Client will be encouraged to use his cane at all times in the ADP.

Maintaining Reassessment Schedule for InterRAI CHA and incorporating it into the daily workflow Supervisor has a report generated monthly to identify which clients are due for a routine re-assessment At this time the supervisor will check the IAR to see if the client has been assessed by any other agencies within the year If no assessment exists an interRAI CHA is completed When an assessment is available in the IAR: it’s usually a RAI HC or an interRAI CHA if it’s an interRAI CHA it’s often not a recent assessment the Supervisor uses the assessment information to assist in conducting an interRAI CHA with the client and/or family Once the interRAI CHA is completed, sometimes new CAPS are generated and the care plan is adjusted accordingly.

Some Lessons We Learned Involve all staff - By involving the Supervisor and Recreation Programmers it keeps us accountable to keep the interRAI CHA’s up to date Try to prevent “over-assessing” - We use the RAI HC and IAR to get as much information as we can so the client and family don’t feel over-assessed Make it your own - Each agency and program are different, so we brainstormed on how it would work for our program

Sustaining the Use of the interRAI CHA Tool to Support Client Care Support available in the Central LHIN for the interRAI CHA/IAR The Central LHIN has recently approved funding for a interRAI CHA/IAR Training Coordinator This position was put into place to support the HSP’s in the Central LHIN for training and use of the interRAI CHA and IAR For more information on this position contact

Thank you!

References Quality Toolkit Data Quality Toolkit: interRAI CHA and Functional Supplement Data Quality Toolkit: interRAI CHA and Functional Supplement Community Support Services Common Assessment Highlights for 2014/2015 CSS Common Assessment Lessons Learned CSS Common Assessment Lessons Learned LHIN Clinical Reports LHIN Operational Reports Understanding the Software-generated CHA Reports Reports Manual PowerPoint Presentation Reports Manual PowerPoint Presentation interRAI CHA Standardized Reports from IAR CHA Reports Descriptions CHA Reports Descriptions interRAI CHA Data Quality Webinar Materials Use of interRAI Community Health Assessment Reports Webinar Use of interRAI Community Health Assessment Reports Webinar Enhancing interRAI CHA Data Quality Webinar From CAPs Outcome Scales to Care Planning Using InterRAI CHA & IAR Standardized Reports To Enhance Client Outcomes

Wrap-up

57 Thank you! Service Desk Contact Information Toll Free: Option 9 Website: