March 2015

Enhancing interRAI CHA Data Quality Webinar

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

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

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

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

What we have heard: Challenges

• Technical challenges • Relevance• Reassessments• Quality of interRAI CHA• Using interRAI CHA outputs

interRAI CHA Outputs

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

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

Assessor Report #1: Client CAPs and Outcomes

Outcome Scales

Demographics

Informal Support Status

CAPs and Actions taken

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

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Assessor Report #2: Client Progression Report

CAPs over time

Outcome Scales overtime

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

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Assessor Report #3: Client Assessment Summary Report

Summary of specific key data elements

Outcome Scales

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

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Organizational Report #1: Clinical Report

Client population acuity

Client count

Software Generated Organizational Reports

Report DescriptionOrganizational 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

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Organizational Report #2: Clinical Report

Acuity by data element by gender, diagnosis, etc

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

Software Generated Organizational ReportsReport 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

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Organizational Report #3: Operational Report

Workload

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

Report #1: Frequency of CAPs triggered

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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

Report #2: Frequency of Outcome Measures/Scales

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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

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

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

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CAPs & Outcome Measures/Scales

Overview

Getting back to Basics

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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

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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

• 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

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CHA Core Assessment

Triggers:1st: G4a – Activity level less than 2 hrs2nd: 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

CAPs triggered from Core Assessment & Functional Supplement

Alison Betty

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

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

Outcome Scales /Measures

Outcome Scale

Range Description

Cognitive Performance Scale (CPS)

0-6 Indicator of Cognitive Status Section C Cognition & Section D Communication

Depression Rating Scale (DRS )

0-14 Indicator of Depression The DRS is based on seven items from Section E1 Indicators of Possible Depressed, Anxious, or Sad Mood

Pain Scale 0-4 Predictor of Pain Based on 2 pain questions, pain frequency and pain intensity

Outcome Scales /Measures

Outcome Scale

Range Description

Self-Reliance Index (SRI)

Score 0 or 1 The SRI categorizes clients as being either self-reliant or impaired

MAPLe 1-5 The Method of Assigning Priority Levels (MAPLe) is used tocategorize clients into five levels of risk for adverse outcomes

Instrumental Activities of Daily Living Involvement Scale( IADL)

0-21 This scale is based upon a sum of seven IADL Self-Performance

Outcome Scales /Measures

Outcome Scale

Range Description

ADL Self-Performance Hierarchy Scale

0-6 The ADL Hierarchy Scale is a measure of ADL performanceCalculated from Core CHA & Functional

Changes in Health, End-stage disease and Signs and Symptoms (CHESS)

0-5 CHESS measures medical complexity and health instabilityCalculated from Core CHA & Functional

interRAI CHA Outcome Measures and Scales

Alison BettyBetty

interRAI CHA Outcome Measures and Scales

BettyAlison

Data Quality

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

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

 

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

Strategies for achieving interRAI CHA Data Quality  

• Conduct Regular Data Quality Reviews

• Develop an Action Plan

• Use of Data Quality Management Tools

Data Quality Management: Checklist

Data Accuracy Review Schedule

Data Accuracy Monitoring Form

Data Accuracy Review Follow Up Plan

Strategies for achieving interRAI CHA Data Quality

• Maintain Staff Skills & Competency for completion of CHA assessments

• Continuous Quality Improvement

• Ongoing Education and Refresher Training

Coding Challenges and Checks:

• Common Coding Errors

• Cross-Validation Checks

• Assessment Look Back Period Exceptions

Common Coding Errors

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.

Assessment Intent Document – Functional Supplement

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interRAI CHA ADL Scoring Guide (G2)

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

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

Assessment Look Back Period Exceptions

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/General/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.ca

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

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Supports• www.ccim.on.ca

for electronic copy of all electronic material

Support Centrecsscap@ccim.on.ca

1-866-909-5600 option 9, select 1 to leave a message

Resources

Classification: Medium

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Wrap- up

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Thank you!

CSS CAP Support CentreContact 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