1. March 2015 Enhancing interRAI CHA Data Quality Webinar

2. Agenda Update –interRAI CHA usage in the sector –Successes and challenges High level review of interRAI CHA outputs and reports Review the value of data quality –Strategies for improving interRAI CHA accuracy –Strategies for achieving data quality

3. interRAI CHA Usage in the Sector Overview: Provincial implementation of interRAI CHA and interRAI Preliminary Screener completed in 2013 Provincial Steering Committee meets quarterly CCIM’s current focus: quality, utility and sustainability of common assessments tools and IAR –interRAI CHA Quality Webinars –CCIM Website –Support Centre

4. interRAI CHA Usage in the Sector interRAI CHA reports available at different levels LHIN clinical and operational reports are based on the aggregate information from common assessments uploaded to the IAR LHIN Activities HSP Activities

5. interRAI CHA Usage in the Sector Successes: 322 HSPs implemented 94% of interRAI CHA’s with consent to share granted Supports the sharing of information to inform service and care planning Some HSPs have started to use the data for quality improvement activities

6. What we have heard: Challenges Technical challenges Relevance Reassessments Quality of interRAI CHA Using interRAI CHA outputs

7. interRAI CHA Outputs

8. What is the interRAI CHA 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 interRAI Community Health Assessment (CHA) helps identify adults needing supports to prevent or stabilize early functional or health decline

9. Software Generated Assessor Reports Report Description Assessor Report #1: Client's CAPs and Outcomes Triggered CAPs and Outcome Measures / Scales for a client Informal Support Status and Hospital / Physician utilization Assessor Report #2: Client Progression Report Assessor Report #3: Client Assessment Summary Report

10. Assessor Report #1: Client CAPs and Outcomes Outcome Scales Demographics Informal Support Status CAPs and Actions taken

11. Software Generated Assessor Reports Report Description Assessor Report #1: Client's CAPs and Outcomes Provides triggered CAPs and Outcome Measures / Scales for a client Informal Support Status and Hospital / Physician utilization Assessor Report #2: Client Progression Report CAPs and Outcome Measures / Scales for one client over time Always shows initial assessment as baseline Assessor Report #3: Client Assessment Summary Report

12. 12 Assessor Report #2: Client Progression Report CAPs over time Outcome Scales overtime

13. Software Generated Assessor Reports Report Description Assessor Report #1: Client's CAPs and Outcomes Triggered CAPs and Outcome Measures / Scales for a client Informal Support Status and Hospital / Physician utilization Assessor Report #2: Client Progression Report CAPs and Outcome Measures / Scales for one client over time Always shows initial assessment as baseline Assessor Report #3: Client Assessment Summary Report A summary of specific key data elements for a client Core interRAI CHA, Functional & Mental Health supplements Outcome Measure / Scales scores

14. 14 Assessor Report #3: Client Assessment Summary Report Summary of specific key data elements Summary of specific key data elements Outcome Scales

15. Software Generated Organizational Reports Report Description Organizational Report #1: Clinical Report Client count and percentage of clients for demographics, CAPs and Outcome Measures / Scales Gives an understanding of the acuity of an HSP’s client population based on CAPs and Outcome Measures / Scales Organizational Report #2: Clinical Report Organizational Report #3: Operational Report

16. 16 Organizational Report #1: Clinical Report Client population acuity Client count

17. Software Generated Organizational Reports Report Description Organizational Report #1: Clinical Report Client count and percentage of clients for demographics, CAPs and Outcome Measures / Scales Gives an understanding of the acuity of an HSP’s client population based on CAPs and Outcome Measures / Scales Organizational Report #2: Clinical Report Overview of the acuity by data element of all active clients of the organization at a point in time Option to run report by selected domains and download then for analysis Organizational Report #3: Operational Report

18. 18 Organizational Report #2: Clinical Report Acuity by data element by gender, diagnosis, etc Acuity by data element by gender, diagnosis, etc

19. 19 Organizational Report #2: Clinical Report (cont’d)

20. Software Generated Organizational Reports Report Description Organizational Report #1: Clinical Report Client count and percentage of clients for demographics, CAPs and Outcome Measures / Scales Gives an understanding of the acuity of an HSP’s client population based on CAPs and Outcome Measures and Scales Organizational Report #2: Clinical Report overview of the acuity by data element of all active clients of the organization at a point in time Option to run report by selected domains and download then for analysis Organizational Report #3: Operational Report Track the number and status of assessments at organizational and assessor levels Provides an understanding of the workload of assessors and status of completing assessments

21. 21 Organizational Report #3: Operational Report Workload

22. interRAI CHA Standardized IAR Reports Report Description Report #1: Frequency of CAPs triggered Understanding the needs of your client population by listing in descending order the frequency of all CAPs triggered Report #2: Frequency of Outcome Measures/Scales Report #3: CHA CAPs and Outcomes Measures Profiles for Client ED visits

23. Report #1: Frequency of CAPs triggered 23

24. interRAI CHA Standardized IAR Reports Report Description Report #1: Frequency of CAPs triggered Understanding the needs of your client population by listing in descending order the frequency of all CAPs triggered Report #2: Frequency of Outcome Measures/Scales Understanding the high risk needs of your client population based on frequency of the Outcome Measures/Scales scores Report #3: CHA CAPs and Outcomes Measures Profiles for Client ED visits Understanding the needs of your client population according to the number of times they visited the ED in last 90 days (before their most recent assessment) based on the frequency of: Clinical Assessment Protocols triggered & Outcome Measures/Scales scores

25. Report #2: Frequency of Outcome Measures/Scales 25

26. interRAI CHA Standardized IAR Reports Report Description Report #1: Frequency of CAPs triggered Understanding the needs of your client population by listing in descending order the frequency of all CAPs triggered Report #2: Frequency of Outcome Measures/Scales Understanding the high risk needs of your client population based on frequency of the Outcome Measures/Scales scores Report #3: CHA CAPs and Outcomes Measures Profiles for Client ED visits Understanding your client population according to the number of times they visited the ED in last 90 days (before their most recent assessment) based on the frequency of: Clinical Assessment Protocols triggered & Outcome Measures/Scales scores

27. Report #3: CHA CAPs and Outcomes Measures Profiles for Client ED visits 27

28. Report #3: CHA CAPs and Outcomes Measures Profiles for Client ED visits 28

29. CAPs & Outcome Measures/Scales Overview

30. Getting back to Basics

31. 31 Assessment Process Flow Core CHA Care Plan Review Review: phone call or visit to review any aspect of the care/service plan Reassessment: face to face comprehensive assessment Supplements CAPs &Outcome Scales Reassessment

32. 32 Clinical Assessment Protocols Structured, problem oriented frameworks to organize information and support care planning Specific clinical characteristics are used to identify clients who could benefit from further evaluation of specific problems either because they are: –at risk for decline or –show potential for improvement Trigger links to a series of problem oriented assessment protocols Clinical expertise and choice is important Not care path/care maps Adapted with expressed permission from ideas for health, University of Waterloo, June 2010

33. Enable client’s strengths, needs and preferences to be taken into consideration when developing the care plan Guide the care plan to resolve potential problems, reduce the risk of decline or increase the potential for improvement Helps the assessor to visualize a complete picture of the client by taking into consideration internal and external factors Will work with all of the interRAI assessment tools Benefits of CAPs

34. 34 CHA Core Assessment Triggers: 1st: G4a – Activity level less than 2 hrs 2nd: G2f- Locomotion-Independent Physical Activities Promotion CAP CAPS link the information gathered in the assessment with the goal of problem resolution, reducing the risk of decline or increasing the potential for improvement How CAPs are triggered

35. CAPs triggered from Core Assessment & Functional Supplement Alison Betty

36. InterRAI CHA Outcome Scales / Measures Used to evaluate the clinical status of a client or group of clients and track their changes over time Software generated Derived from data collected by the completion of the InterRAI CHA assessments

37. Use of Outcome Scales/Measures: Benefits Information on client needs, complexity of clients in your HSP Information to prioritize quality improvement activities Evidence based for decision making

38. Outcome Scales /Measures Outcome Scale Range Description Cognitive Performance Scale (CPS) 0-6Indicator of Cognitive Status Section C Cognition & Section D Communication Depression Rating Scale (DRS ) 0-14Indicator of Depression The DRS is based on seven items from Section E1 Indicators of Possible Depressed, Anxious, or Sad Mood Pain Scale0-4Predictor of Pain Based on 2 pain questions, pain frequency and pain intensity

39. Outcome Scales /Measures Outcome Scale Range Description Self-Reliance Index (SRI) Score 0 or 1The SRI categorizes clients as being either self-reliant or impaired MAPLe1-5The Method of Assigning Priority Levels (MAPLe) is used to categorize clients into five levels of risk for adverse outcomes Instrumental Activities of Daily Living Involvement Scale( IADL) 0-21This scale is based upon a sum of seven IADL Self-Performance

40. Outcome Scales /Measures Outcome Scale Range Description ADL Self- Performance Hierarchy Scale 0-6The ADL Hierarchy Scale is a measure of ADL performance Calculated from Core CHA & Functional Changes in Health, End- stage disease and Signs and Symptoms (CHESS) 0-5CHESS measures medical complexity and health instability Calculated from Core CHA & Functional

41. interRAI CHA Outcome Measures and Scales Alison Betty

42. interRAI CHA Outcome Measures and Scales Betty Alison

43. Data Quality

44. 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

45. Strategies for improving interRAI CHA Data /Coding Accuracy Accurate Coding Assessment practices Review all documentation / records Follow Best Practice Guidelines for the InterRAI CHA Reassessment

46. Strategies for improving interRAI CHA Data /Coding Accuracy Check that all the sections are completed and that the assessment is signed off as required. Check that the ARD dates are accurate and that the look back periods are correct Ensure that the coding is accurate and that it represents the clinical status of the client

47. Strategies for achieving interRAI CHA Data Quality Conduct Regular Data Quality Reviews Develop an Action Plan Use of Data Quality Management Tools

48. Data Quality Management: Checklist

49. Data Accuracy Review Schedule

50. Data Accuracy Monitoring Form

51. Data Accuracy Review Follow Up Plan

52. Strategies for achieving interRAI CHA Data Quality Maintain Staff Skills & Competency for completion of CHA assessments Continuous Quality Improvement Ongoing Education and Refresher Training

53. Coding Challenges and Checks: Common Coding Errors Cross-Validation Checks Assessment Look Back Period Exceptions

54. Common Coding Errors

55. Assessment Intent Document – Core interRAI CHA This tool is not intended to replace the Core CHA assessment. It is intended as a support document to assist assessors with helpful tips in askingsome of the more challenging assessment questions. It does not provide you with coding options. Intent column is from the interRAI Coding Manual.

56. Assessment Intent Document – Functional Supplement

57. 57 interRAI CHA ADL Scoring Guide (G2)

58. Cross-Validation Checks: True of False? If a client is coded in the Core: J6a-pain frequency as 0 (no pain) then for the Core: J6 b, c, d J6b-intensity of highest level of pain present J6c-consistency of pain J6d-breakthrough pain  Code all as 0 (no pain) Answer: True

59. Cross-Validation Checks: If a client is coded in the Core: G2f (locomotion on same floor) as 6 (total dependence) a)FS: D2a-timed 4 meter walk must be coded as 99 (not tested) b)FS: D2b-distance walked must be 0 (did not walk) c)FS: D2c-distance wheeled self must be 0 (wheeled by others) d)All of the above Answer d) All of the above

60. Assessment Look Back Period Exceptions

61. Integrated Assessment Record LHINs have access to aggregate clinical and will have access to operational information through standardized reports based on the assessments your HSP uploads to the IAR. As part of the assessment standard, all completed assessments should be uploaded to the IAR. Uploading all assessments ensures availability of assessments for sharing, within the circle of care, and more accurate clinical reports The consent you gather determines if an uploaded assessment can be viewed through the IAR. If consent is not granted, the assessment cannot be viewed. Remember to work with you user coordinator to ensure that if staff has left your organization, their IAR accounts are removed from the system. Please see link below: –https://www.ccim.on.ca/IAR/Private/Document/Forms%20and%20Guides/G eneral/IPAddressAddRemoveChange_20130523_v1.0_AEM.dochttps://www.ccim.on.ca/IAR/Private/Document/Forms%20and%20Guides/G eneral/IPAddressAddRemoveChange_20130523_v1.0_AEM.doc Consider ways to include use of IAR in your workflow to support service planning and care coordination If your are having issues with uploading or viewing assessment within the IAR, please contact the IAR Support Centre at: Telephone: 1-866-909-5600 Email: iar@ccim.on.caiar@ccim.on.ca

62. Key Messages: Planning for Data Quality Accurate interRAI CHA and Functional Supplement is the foundation for reliable CAPs and Outcome Scales HSP reports – software-generated and standardized IAR Sample tools for monitoring data quality Tips to enhance coding accuracy CCIM resources

63. 63 Supports www.ccim.on.ca for electronic copy of all electronic material Support Centre csscap@ccim.on.ca 1-866-909-5600 option 9, select 1 to leave a message Resources

64. Classi ficatio n: Mediu m 64 Wrap- up

65. 65 Thank you! CSS CAP Support Centre Contact Information Email: csscap@ccim.on.ca Toll Free:1-866-909-5600, Option 9, press 1 to leave a voicemail message Website: www.ccim.on.ca