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Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2
Resident Assessment Instrument - Minimum Data Set (RAI-MDS) Presentation to Family Councils’ Durham Wednesday, October 22, 2008 Soo Ching Kikuta, RN, MScN, Business Lead, LTCH CAP Jennifer Ratcliff, Communications Lead, LTCH CAP
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Presentation Overview
Part A: Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS 2.0) Part B: Long-Term Care Homes Common Assessment Project (LTCH CAP) 2
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Part A: Resident Assessment Instrument- Minimum Data Set (RAI-MDS) 2.0
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Alberta Resident Classification System (ARCS)
External Classifier Assess Nursing and Personal Care Needs of Resident Output - FUNDING Home Case Mix Measure (CMM) Sum of care levels of all A to G residents in the home Home Case Mix Index (CMI) Snapshot - annually Relative number used for funding Based on 8 indicators: eating, toileting, transferring, dressing, potential for injury, ineffective coping, urinary continence bowel continence 4
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ARCS and RAI-MDS 2.0 (Examples)
Funding tool Focuses and rewards disability - no incentive with financial penalty to do rehabilitation, and preventative care Participates by selected registered staff members in the process - no interdisciplinary team involvement Funding output: CMI and CMM by home and provincial No linkage to resident care, care planning or quality improvement A clinical tool that enhances the assessment, develops an effective care plan, and improves resident care Values restorative, enablement, rehabilitation, health promotion and prevention Requires involvement of the resident, family/significant others and care team members Builds-in monitoring system and can generate multiple output reports for tracking and monitoring of resident care progress and improvement quarterly Multiple applications: care plan development, quality improvement, accreditation, benchmarking, data quality, funding, resource allocation, strategic planning, performance evaluation 5
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Ontario RAI-MDS 2.0 Implementation in Long-Term Care Homes
625 Homes (77,228 beds) 35% of homes in Ontario are using RAI-MDS 2.0 (representing 217 homes across all LHINs) 100% of home participation has been voluntary 6
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interRAI Countries Nordic Countries North America Canada, USA Europe
Iceland, Norway, Sweden, Denmark, Finland North America Canada, USA Europe Netherlands, Germany, Switzerland, France, UK, Italy, Spain, Czech Republic, Poland, Estonia Middle East Israel Pacific Rim Japan, China, Taiwan, Hong Kong, South Korea, Australia, New Zealand 7
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RAI-MDS 2.0 Instrument Adoption in Canada
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The Core Function of RAI-MDS
Designed as a clinical tool that enhances the assessment, develops an effective care plan, and improves resident care Records information in a standardized, holistic and interdisciplinary assessment tool (Minimum Data Set - MDS) Identifies the majority of a resident’s strengths, needs and preferences to guide the staff in developing a more comprehensive, appropriate and individualized care plan Captures residents’ care needs over 24 hours 9
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RAI-MDS 2.0 Model Assessment Case Mix/ Resource Utilization Groups
Minimum Data Set Outcome Measurement Scales Resident Assessment Protocols (RAPs) Triggers Quality Indicators Plan of Care 10
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The MDS Assessment The MDS assessment tool has 19 sections with over 450 assessment items in the categories of: Oral/Nutritional Status Oral/Dental Status Skin Condition Activity Pursuit Patterns Medications Special Treatments and Procedures Discharge Potential and Overall Status Assessment Information U. Medication List Identification Information Cognitive Patterns Communication/Hearing Patterns Vision Patterns Mood and Behaviour Patterns Psychosocial Well-Being Physical Functioning and Structural Problems Continence Disease Diagnoses Health Conditions 11
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Resident Assessment Protocols (RAPs)
RAPs are potential or actual problems that may require further assessment. There are 18 RAPs triggered by specific resident responses from one or a combination of MDS elements: Activities Falls Nutritional status Feeding tubes Dehydration/fluid maintenance Dental care Pressure ulcers Psychotropic drug use Physical restraints Delirium Cognitive loss/dementia Visual function Communication ADL function/rehabilitation Urinary incontinence and indwelling catheter Psychosocial well-being Mood state Behavioral symptoms 12
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From Home Software: Reports Outcome Scales Quality Indicators
Resource Utilization Groups (RUGs) RAI-MDS 2.0 outputs RAI-MDS 2.0 assessment data is to be submitted electronically to Canadian Institute for Health Information (CIHI) quarterly. 13
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Outcome Scales Derived from MDS data (no extra work - it is calculated by the software, real time data!) Aggregates information on resident needs and outcomes Can be used to evaluate the resident’s clinical status at present and change over time Comparative reports (by unit, resident, program and Home) 14
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Outcome Scales Scale Measures Cognitive Performance Scale (CPS)
Level of cognition Depression Rating Scale (DRS) Level of depression Activity of Daily Living (ADL Short Form, ADL Long Form, ADL Hierarchy) ADL performance Changes in Health, End-Stage Disease and Signs and Symptoms Scale (CHESS) Predictor of mortality Index of Social Engagement (ISE) Degree of social engagement Pain Scale Prevalence of pain 15
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Quality Indicators (QIs)
Flagging or identifying exemplary care and potential care concerns Not direct measuring of quality Monitoring resident’s risk or condition change and progress over time Identifying residents for review 16
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Quality Indicators (QIs)
There are 24 QIs for long-term care homes New fractures Falls Behavioural symptoms affecting others Symptoms of depression Depression with no antidepressant therapy Use of nine or more medications Cognitive impairment Bladder or bowel incontinence Occasional or frequent bladder or bowel incontinence without a toileting plan Indwelling catheters Fecal impaction Urinary tract infections Weight loss Tube feeding Dehydration Bedfast residents Decline in late-loss ADLs Decline in ROM Anti-psychotic use in the absence of psychotic or related conditions Anti-anxiety / hypnotic use Hypnotic use more than two times in last week Daily physical restraints Little or no activity Stage pressure ulcers 17
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Resource Utilization Groups (RUGs)
Upon completion of the MDS, the software automatically classifies residents into groups There are 7 major groups, further divided into 44 distinct subcategories These groups classify residents according to their clinical and diagnostic characteristics and resource utilization 18
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Resource Utilization Groups (RUGs III)
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Multiple Uses for Data Collected at Point of Care
e.g. Are we getting the best outcomes for our health care dollars? How effective are our services? What are the priorities for quality improvement? Clinical Decision-making Clinical & Utilization Research Public Accountability e.g. What are the outcomes of care? Do our residents achieve their health goals? What resources were used? e.g. Do Ontarians' have equitable access to quality health services and how do we compare with other provinces? Operational & Strategic Management RAI-MDS 2.0 Assessment 20
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Benefits: Residents and Family Members
Encourages resident and family involvement Respects the value of helping residents achieving their highest level of functioning and quality of life Offers a holistic interdisciplinary assessment of resident care needs and the development of a focused, individualized care plan Flags actual and potential resident care needs in a timely fashion 21
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What Families have said:
“We were very impressed with the Home. We have noticed Mum is much happier, especially in bed, and is not complaining of pain as much. She is not on as many medications. The Home explained everything they were doing. They treat her like family”. “My brother felt like someone was finally paying attention to him. I noticed small improvements - he could walk on the carpet or out on the deck and he was able to dress himself. I was told what was being done and when I knew about his depression, I could watch out for signs of it and tell the staff”. “The variability in the care delivery worried me. RAI-MDS makes a big difference. It helps the staff give the same level of care, regardless of which PSW is on shift. When someone is new, they can quickly be better informed”. 22
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Benefits: Care Providers
Provides a common resident care approach in assessment and care planning Increases awareness regarding residents’ strengths, symptoms, needs and preferences Provides access to real time clinical information of residents; pinpoints underlying conditions unseen or yet to emerge Helps to improve clinical practice by: - Tracking resident-specific outcomes and - Monitoring resident change over time Improves resident teaching - related to ‘readiness for discharge’ 23
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What Care Providers have said:
“I must emphasize how important the family involvement is, they are truly a part of the care team and we need their information to help us form the best possible care plan… they provide a wealth of information and are key in the care plan development process.” - RAI Coordinator 24
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Benefits - Administration or Executives
Enables informed decisions to be made regarding staffing, resource allocation, risk management, program planning, strategic planning and utilization by connecting RAI-MDS information with other management information Contains clinical data to benchmark with other homes, has ability to identify and learn from industry leaders and sharing of best practices Provides timely access to performance information to evaluate the home and track record of evidence Improves staff training related to evidence of clinical performance 25
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What Management has said:
“(MDS) has enabled the resident and family to have greater input into the plan of care. The plan of care becomes more personalized. The front line staff feel that they have a greater say about the resident.” - Nursing Home Manager 26
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Benefits - Health Care System
Informs public reporting on health system performance - empowers the consumer Enhances the availability of consistent, comprehensive and quality data in an open and transparent approach Improves confidence of the long-term care sector Enhances information, aids benchmarking, policy development and sector planning 27
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Lessons Learned - Benefits
“The implementation of RAI MDS increases team communication” “Residents appreciate their added involvement in the assessment” “With the implementation of RAI MDS 2.0 processes, we improve the co-ordination of resident assessment and interdisciplinary team meetings because MDS provides a common language” “Our PSWs are feeling more engaged and valued by their increased participation in assessment” “The MDS has uncovered underlying clinical conditions resulting in proactive treatment for residents” “All discipline documentation is centralized…reduces discrepancies in documentation…and a more holistic view of the resident” “Better care plan and more individualized” “Given the high turnover of staff…the MDS assessment…helps safeguard and protect our residents….newly hired employees…may miss important assessment, however the MDS [is] foolproof” 28
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Part B: Long-Term Care Homes Common Assessment Project (LTCH CAP)
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Local Health Integration Networks
Continuing Care e-Health Program Footprint Local Health Integration Networks Program Streams CCAC CSS CMH & A LTCH Common Assessments HC CAP (CIAT) CMH CAP (CMHCA) LTCH CAP (RAI MDS) HC CAP (LSAS) Business Systems CSS MIS CMH&A MIS FSMS LTCH MIS CSS HRIS CMH&A HRIS Architecture & Integration Standards Security, Privacy & Risk Management Project Legend CAP = Common Assessment Project CCM = Common Case Management CIAT = Common Intake Assessment Tool CMH&A = Community Mental Health & Addictions CSS = Community Support Services HC = Home Care FSMS= Financial & Statistical Mgmt Systems HRIS = Human Resources Information System LSAS = Long Stay Assessment Software LTCH = Long-Term Care Home MIS = Management Information Systems RAI-MDS = Resident Assessment Tool Min. Data Set Completed project Project Rolling Out Project in pilot 30
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Implementation Timelines
Phase 6 Phase 7 Phase 8 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 09/10 31
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Project Implementation Model
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Requested Participants
Education Modules Module Description Requested Participants Training Day 1a Home Preparation * Administrator, DOC, RAI Coordinator & Backup 1 1b RAI Coordinator Forum (RAI Coordinator & Backup) RAI Coordinator and Backup 2 Assessment (Coding) DOC, RAI-C and Backup 3 Data Submission 4 hrs. Web-X 4 RAI Outputs/Reports* Administrator, DOC, RAI-C and Backup 5 Data Quality Management 2 hrs. 6 RAPs and Care Planning Total Training Days = 6 days; 6 hours Web-X Timeline = 9-12 Months 33
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Regional Training and Support Teams
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Implementation Support
Site Visit Implementation Toolkit Designated RAI Educator AIS DART CIHI User’s Manual Phone Support RAI-MDS Nutritional Care Resource Guide Regional Teleconference Support Mentorship Program 35
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Implementation Support
Implementation Toolkit: training, presentations, tools, checklists 60 Minutes audio presentations Continuous training schedule Project e-Newsletter Frequently Asked Questions for Coding and Data Submission Discussion Boards for Homes On-Line Web Portal 36
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Implementation Support
In-person help desk or Operating 8:30 a.m. – 4:30 p.m. Monday to Friday (with password) Support Centre 37
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Contact information Long-Term Care Homes Common Assessment Project or 38
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Questions? 39
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