Arkansas HCBS Provider Meeting Mary James, MA Brant Fries, PhD University of Michigan/interRAI Little Rock, Arkansas August 8, 2013

UM Agenda l Review philosophy, structure, process behind interRAI assessment systems l Summarize ARLOC algorithm development process l Examine ARLOC structure l Address other issues of concern

©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 2012 – Do not duplicate or distribute 4 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

©interRAI 2012 – Do not duplicate or distribute 5 Applications of interRAI Data ASSESSMENT Care Planning ScreeningQuality Case-MixPolicy

interRAI HC and interRAI ID HC 121 Items ID 123 Items 69 Other Shared Items 128 Core Items 441 Items Total

interRAI HC and interRAI CMH HC 151 Items CMH 238 Items 57 Other Shared Items 110 Core Items 556 Items Total

©interRAI 2012 – Do not duplicate or distribute 8 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

©interRAI 2012 – Do not duplicate or distribute 9 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

©interRAI 2012 – Do not duplicate or distribute 10 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!

©interRAI 2012 – Do not duplicate or distribute 11 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

©interRAI 2012 – Do not duplicate or distribute 12 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

©interRAI 2012 – Do not duplicate or distribute 13 Cognitive Performance Scale CPS 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

©interRAI 2012 – Do not duplicate or distribute 14

©interRAI 2012 – Do not duplicate or distribute 16 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

©interRAI 2012 – Do not duplicate or distribute 17 IADL Coding 0 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)

©interRAI 2012 – Do not duplicate or distribute 18 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.?

©interRAI 2012 – Do not duplicate or distribute 19 ADL Coding Coding: actual level of involvement in self care 0- Independent 1-Set-up help only 2-Supervision: oversight, encouragement, or cueing provided 3 or more times during the period 3- 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 another 8- Activity did not occur: ADL activity was not performed by person or others (regardless of ability)

ARLOC Algorithm Design l Cross-walk policy to items on iHC l Confer with DHS staff; modify as needed l Run ARLOC on test cases; OLTC staff independent 703 review; compare outcomes l Modify as needed l Run in real-time with 100% OLTC review l Modify as needed l Adopt for ongoing use