Development and Maintenance of Standardized Cross Setting Patient Assessment Data for Post-Acute Care: Summary Report of Findings from Alpha 1 Pilot Testing (original) (raw)
Related papers
2018
The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and develop standardized items for use in post-acute care patient assessment instruments. RAND was tasked by CMS with developing and testing items within five areas of focus that fall under the clinical categories delineated in the Improving Medicare Post-Acute Care Transformation Act of 2014: (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories. This report presents results of the Alpha 2 feasibility test of a set of candidate items for assessing some of these focus areas. Conducted between April 2017 and July 2017, the test was the second of two Alpha tests used to assess the feasibility of candidate items. Like the Alpha 1 test, the results of this small-scale feasibility test informed the design of the national Beta test. This work was sponsored by CMS under contract No. HHSM-500-2013-13014I. The research was conducted in RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of its publications, and ordering information can be found at www.rand.org/health.
Developing quality indicators for in-patient post-acute care
BMC Geriatrics, 2018
Background: This paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for use in in-patient post-acute environments that use the assessments. Methods: Data Source: MDS 3.0 computerized assessments mandated for all patients admitted to US skilled nursing facilities (SNF) in 2012. In total, 2,380,213 patients were admitted to SNFs for post-acute care. Definition of the QI numerator, denominator and covariate structures were based on MDS assessment items. A regression strategy modeling the "discharge to the community" PAC QI as the dependent variable was used to identify how to bring together a subset of seven candidate PAC QIs for inclusion in a summary scale. Finally, the distributional property of the summary scale (the PAC QI Summary Scale) across all facilities was explored. Results: The risk-adjusted PAC QIs include indicators of improved status, including measures of early, middle, and late-loss functional performance, as well as measures of walking and changed clinical status and an overall summary functional scale. Many but not all patients demonstrated improvement from baseline to follow-up. However, there was substantial interstate variation in the summary QI scores across the SNFs. Conclusions: The set of PAC QIs consist of five functional, two discharge and eight clinical measures, and one summary scale. All QIs can be derived from multiple interRAI assessment tools, including the MDS 2.0, interRAI-LTCF, MDS 3.0, and the interRAI-PAC-Rehab. These measures are appropriate for wide distribution in and out of the United States, allowing comparison and discussion of practices associated with better outcomes.
Use of Patient-Reported Data within the Acute Healthcare Context: A Scoping Review
International Journal of Environmental Research and Public Health
Patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs) and patient satisfaction surveys provide important information on how care can be improved. However, data collection does not always translate to changes in practice or service delivery. This scoping review aimed to collect, map and report on the use of collected patient-reported data used within acute healthcare contexts for improvement to care or processes. Using JBI methods, an extensive search was undertaken of multiple health databases and trial registries for published and unpublished studies. The concepts of interest included the types and characteristics of published patient experience and PROMs research, with a specific focus on the ways in which data have been applied to clinical practice. Barriers and facilitators to the use of collected data were also explored. From 4057 records, 86 papers were included. Most research was undertaken in North America, Canada or the UK. The Hospital Con...
Journal of Nursing & Care, 2018
A systematic and early biopsychosocial assessment of older patients in acute care hospitals is necessary for a proactive and effective discharge plan in order to identify patients at risk for a care deficit after hospitalization. Our study aim was to adapt the, "Post Acute Care Discharge" (PACD) Scores developed in Geneva for use in the Cantonal Hospital of Aarau and evaluate as screening instruments in selected medical patients in a medical university clinic. Among 308 patients admitted from home with urinary tract infections, falls, syncope or heart failure day 1 PACD ≥ 8 had a sensitivity of 90% and a specificity of 62% and day 3 PACD ≥ 8 a sensitivity of 80% and a specificity of 60% to identify a nursing care deficit. The PACD is used as a screening instrument to identify patients at risk and therefore facilitate a structured, interdisciplinary and patient-centered analysis of the situation and discharge plan.
Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument
Journal of the American Geriatrics Society, 2000
OBJECTIVES: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument. DESIGN: Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability. SETTING: Acute medical, acute geriatric and orthopedic units in 13 hospitals in nine countries. PARTICIPANTS: Five hundred thirty-three patients aged 70 and older (mean age 82.4, range 70-102) with an anticipated stay of 48 hours or longer of whom 161 received duplicate assessments. MEASUREMENTS: Sixty-two clinical items across 11 domains. Premorbid (3-day observation period before onset of the acute illness) and admission (the first 24 hours of hospital stay) assessments were conducted. RESULTS: The frequency of deficits exceeded 30% for most items, ranging from 1% for physically abusive behavior to 86% for the need for support in activities of daily living after discharge. Common deficits were in cognitive skills for daily decision-making (38% premorbid, 54% at admission), personal hygiene (37%, 65%), and walking (39%, 71%). Interrater reliability was substantial in the premorbid period (average k 5 0.61) and admission period (average k 5 0.66). Of the 69 items tested, less than moderate agreement (ko0.4) was recorded for six (9%), moderate agreement (k 5 0.41-0.6) for 14 (20%), substantial agreement (k 5 0.61-0.8) for 40 (58%), and almost perfect agreement (k40.8) for nine (13%). CONCLUSION: Initial assessment of the psychometric properties of the interRAI Acute Care instrument provided evidence that item selection and interrater reliability are appropriate for clinical application. Further studies are required to examine the validity of embedded scales, diagnostic algorithms, and clinical protocols. J Am Geriatr Soc 56:536-541, 2008.
Short-form activity measure for post-acute care
Archives of Physical Medicine and Rehabilitation, 2004
Objective: To develop a comprehensive set of short forms using item response theory (IRT) and item pooling procedures for the purpose of monitoring postacute care functional recovery. Design: Prospective study. Setting: Six postacute health care networks in the greater Boston area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. Participants: A convenience sample of 485 adult volunteers who were currently receiving skilled rehabilitation services. Interventions: Not applicable. Main Outcome Measures: We developed a set of 6 short forms across 3 activity domains from new items and items from existing postacute care instruments. Results: Inpatient-and community-based short forms were developed for each of 3 activity domains: physical & movement, applied cognition, and personal care & instrumental. Items were selected for inclusion on the short forms to maximize content coverage and information value of items across the range of content and to minimize ceiling and floor effects. We were able to match the distribution of sample scores with very good item precision for 1 of the constructs (physical & movement); the other 2 domains (personal care & instrumental, applied cognition) were more challenging because of the variability in patient recovery and ceiling effects. Conclusions: ITR methods and item pooling procedures were valuable in developing paired sets of short-form instruments for inpatient and community rehabilitation that provided estimates of functioning along a common metric for use across postacute care settings.
Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients. A survey of Electronic Medical Record data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single variable risks. The model's validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals. Outcome validation across hospitals yields an area under the receiver operating characteristic curve (AUC) of P0.92 when separating hospice/deceased from all other discharge categories, an AUC of P0.93 when predicting 24-h mortality and an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomes reflective of patient condition across the acuity spectrum indicates utility in both medical-surgical units and critical care units. The model output, which we call the Rothman Index, may provide clinicians with a longitudinal view of patient condition to help address known challenges in caregiver communication, continuity of care, and earlier detection of acuity trends.
Controlled Clinical Trials, 1991
Before being introduced to wide use, health status instruments should be evaluated for reliability and validity. Increasingly, they are also tested for responsiveness to important clinical changes. Although standards exist for assessing these properties, confusion and inconsistency arise because multiple statistics are used for the same property; controversy exists over how to measure responsiveness; many statistics are unavailable on common software programs; strategies for measuring these properties vary; and it is often unclear how to define a clinically important change in patient status. Using data from a clinical trial of therapy for back pain, we demonstrate the calculation of several statistics for measuring reproducibility and responsiveness, and demonstrate relationships among them. Simple computational guides for several statistics are provided. We conclude that reproducibility should generally be quantified with the intraclass correlation coefficient rather than the more common Pearson r. Assessing reproducibility by retest at one-to-two week intervals (rather than a shorter interval) may result in more realistic estimates of the variability to be observed among control subjects in a longitudinal study. Instrument responsiveness should be quantified using indicators of effect size, a modified effect size statistic proposed by Guyatt, or the use of receiver operating characteristic (ROC) curves to describe how well various score changes can distinguish improved from unimproved patients.