SPEED Rounds
October 6,, 2011
Uniform Assessment System – New York: Research, Evaluation,
Planning and Implementation of an automated,
uniform
if
assessment system
Carla R
R. Williams,
Williams Deputy Director
Director,
Division of Long Term Care,
Office of Health Insurance Programs
g
1
UAS – NY: Goal
Develop a comprehensive assessment instrument that:
Evaluates an individual’s health status, strengths, care
needs and preferences.
needs,
preferences
Guides the development of individualized long term
care service plans.
plans
Ensures that individuals with long term care needs
g care, within the right
g settingg and at
receive the right
the right time.
2
Current Environment
Multiple screening and assessment tools in current use
complicates an already fragmented and poorly
coordinated delivery system.
Many instruments lack standardization, have not been
tested for reliability or validity, and are not automated.
Care plans and referrals are open to subjectivity.
3
Objectives of UAS - NY
Assess
individual’s
A
i di id l’ ffunctional
i l needs
d and
d abilities
bili i through
h
h
empirically tested and validated means.
Provide accurate data to develop individualized plans of
care that are consumer-driven, build on consumer
strengths and offer consumer choice.
Identify level of care.
Assist with care pplanningg and oversight.
g
Reduce redundancy.
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Objectives
j
IImprove the
h quality,
l consistency, and
d accuracy off
assessment and care plans.
Enhance the state’s
state s capacity for program development
and policy decisions that are data-driven.
Increase access to data by multiple providers via
electronic means.
Provide compatibility with other data sets and align with
existing standards to the extent possible.
5
Background
Extensive
te s ve review
ev ew of
o literature
te atu e to identify
e t y uuniform
o data
ata
sets and assessment instruments developed by other
states and countries.
Secured expertise to validate preliminary findings and
recommendations.
6
Learning from Other States and
Countries
Conducted focused discussions about uniform assessment instruments,
instruments e.g.,
eg
Washington, Michigan, Massachusetts, New Jersey, Maine, Louisiana, Canada.
Why particular tool was chosen/developed.
How was the business plan developed, from goals to
implementation.
Functions of the tool.
Settings in which the tool is used.
Stake holder support.
Screening process to determine who gets the in-home assessment.
Training needs and resources.
Inter rater reliability.
reliability
Inter-rater
7
Tool Selection
Two ppossibilities surfaced:
CMS CARE.
interRAI Community Health Assessment.
Assessment
An interRAI Community Health Assessment was chosen
(interRAI CHA).
8
InterRAI Capabilities
p
Evaluates an individual’s health status, care needs and
preferences.
preferences
By design, compatible in key areas with the nursing home RAI.
Consistent, standardized,
Consistent
standardized and validated level of care and
assessment.
Automatable.
High inter-rater reliability.
Data set can be used across settings with customization for
specific settings.
Reasonable length of assessment.
Available for use.
9
KEY
Y DOMAIN
NS
interRAI – CHA Key Domains:
Identification Information
O l and
Oral
d Nutritional
N t iti
l St
Status
t
Intake and Oral History
Skin Condition
Cognition
Medications
Communication and Vision
Treatment and Procedures
Mood and Behavior
Responsibility
P h
Psychosocial
i l Well-being
W ll b i
Social Supports
Functional Status
Environmental Assessment
Continence
Disease Diagnoses
Discharge Potential and
Overall Status
Health Condition
Discharge
Assessment Information
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Clinical Assessment Protocols (CAPs)
KEY CAPs
Problem-focused
Problem focused conditions that are common risks:
Functional Performance
Bladder Management
Sensory
y Performance
Health Problems/Syndromes
y
Mental Health
Service Oversight
11
Development for Software and Training
Evaluate the interRAI CHA vis-à-vis programs and
regulations.
g
Map the current assessment process in all programs.
Document use of the current assessment.
assessment
Identify outcomes and initiate curriculum for assessor
education program.
program
Computer readiness survey of users.
B
Beta
testing
i preparation.
i
Web-based training being created.
Training tools incorporated into software.
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Scope
interRAI:
Community Health Assessment
Functional Supplement
Mental Health Supplement
Scales, Triggers, CAPs, RUG III
New York State Adds:
Skilled Nursing Facility Level of Care
New York State-Specific Data
Summary Output Will Support:
Service Planning
Care Planning
Case Management
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System Structure
Department of Health
Health Commerce System
User Login and Authentication
System Security
Ability to Work “off-line”
Off-line Assessment
Other Remote Connection
14
Iterative Development
Phase 1 began May 2011:
P j
Project
Pl i
Planning
Phase II to be completed end of October:
Initial system iteration
15
UAS NY Project Schedule
UAS-NY
I
Iterative
i Development
D l
C
Cycle
l
Iteration 1: May - July
Iteration 2: August - October
Iteration 3: November - December
Iteration 4: JJanuaryy - Februaryy
Iteration 5 BETA: March - May
Final Candidate Cycle: May - June
Pilot Implementation: June - September
State-wide Implementation
September 2012 onward
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Questions:
[email protected]
@h lth t t
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