Data Quality:
Approaches Used to Support the
Quality & Utility of the interRAI CHA
and IAR for Client Care
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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?
interRAI Community Health Assessment (CHA) helps
identify adults needing supports to prevent or stabilize early
functional or health decline
•
•
•
•
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
4
Care Planning: Putting it all together
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
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
interRAI CHA
&
Supplements
Care
Planning
Outcome
Scales
CAPs
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
HSP Level
Standardized Reports
(based on the interRAI CHA)
LHIN Level
Standardized Reports
Software Generated:
3 Assessor Reports
3 Organizational Reports
IAR Portal:
3 Clinical Reports
IAR Portal:
3 Operational Reports
3 Clinical Reports
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
Continuous Quality Improvement
InterRAI CHA
Completion
Review Generated
CAPS & Outcome
Scales
Data Quality
InterRAI CHA
Software & IAR
Reports
Care / Service
Planning
Integrated
Assessment
Record
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
Challenges
Lessons 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
Challenges
Lessons 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
Karen Blackley, eHealth Program Manager
Central LHIN
15
Central LHIN CA & IAR Adoption Project – CSS
Updates
•
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
•
16
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
•
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
•
17
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: 905-948-1872 or 1-866-392-5446
Fax: 905-948-8011
Email: [email protected]
www.centrallhin.on.ca
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 selfdirect 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
26
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
Who we are and what we do
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)
Implementation of the interRAI CHA and interRAI
Preliminary Screener
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 2010 -2011, 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 journey 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.
1: Sustaining the use of the interRAI CHA and
Preliminary Screener tools to support client care
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
2: Maintaining standards and data quality of the
assessment information entered into the interRAI CHA
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.
3: Maintaining reassessment schedule for interRAI CHA
and incorporating it into the daily workflow
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
4: Maintaining an understanding and usage of
interRAI CHA outputs to support client outcomes
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
5: Maintaining technology in order to ensure data
submission of the interRAI CHA to the IAR and access to
reports
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.
Reports
Assessor Report #1
Client's CAP's and
Outcomes
- Show only triggered CAP's and
Outcome Measures for one client
Assessor Report #2
Client Progression
Report
- Show CAP's and Outcome
Measures for one client over time
Assessor Report #3
Client 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
ADS Clients
MAPLe and CHESS
50%
44%
45%
0 Stable
41%
40%
1 Low level of medical complexity and instability
35%
2 Mild level of medical complexity and instability
30%
3 Moderate level of medical complexity and
instability
26%
25%
23%
4 High level of medical complexity and instability
20%
15%
15%
13%
10%
10%
Total
8%
5%
5%
3%
3%
3%
0% 0%
5%
3%
0% 0%
0%
Maple 5 Very high
Maple 4 High
5 Very high level of complexity and instability
Maple 3 Moderate
n=39
Questions?
45
St. Clair West Services for Seniors
2562 Eglinton Avenue West
2nd Floor, Suite 202
Narain Motwani, MSW, RSW
Toronto, ON M6M 1T4
Manager of Client Services
Phone: 416-787-2114
Fax: 416-787-8552
www.servicesforseniors.ca
[email protected]
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 Triggered
Physical activity
promotion
Care plan Goals
To increase hours of exercise
and physical activity.
Prevent loss of independent
function.
Falls 2- high risk for Reduce risk and frequency
falls
of falls
Care plan interventions
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.
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
[email protected]
Thank you!
References
Quality Toolkit
Data Quality Toolkit: interRAI CHA and Functional Supplement
Community Support Services Common Assessment Highlights for 2014/2015
CSS Common Assessment Lessons Learned
LHIN Clinical Reports
LHIN Operational Reports
Understanding the Software-generated CHA Reports
Reports Manual
PowerPoint Presentation
interRAI CHA Standardized Reports from IAR
CHA Reports Descriptions
interRAI CHA Data Quality Webinar Materials
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
Thank you!
Service Desk
Contact Information
Email:
Toll Free:
Website:
57
[email protected]
1-866-909-5600
Option 9
www.ccim.on.ca