The Development and Testing of the Continuity Assessment Record and Evaluation

466 Pages·2017·15.48 MB·English

Himmelfarb Health Sciences Library, The George Washington University
Health Sciences Research Commons
Clinical Research and Leadership Faculty
Clinical Research and Leadership
Publications
8-2012
The Development and Testing of the Continuity
Assessment Record and Evaluation (CARE) Item
Set, Volume 1 of 3
Barbara Gage
Roberta Constantine
Jyoti Aggarwal
Melissa Morley
Vera Kurlantzick
See next page for additional authors
Follow this and additional works at:https://hsrc.himmelfarb.gwu.edu/smhs_crl_facpubs
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APA Citation
Gage, B., Constantine, R., Aggarwal, J., Morley, M., Kurlantzick, V., Bernard, S., Munevar, D., Garrity, M., Smith, L., Barch, D., Deutsch,
A., Mallinson, T., & Ehrlich-Jones, L. (2012). The Development and Testing of the Continuity Assessment Record and Evaluation
(CARE) Item Set, Volume 1 of 3.,(). Retrieved fromhttps://hsrc.himmelfarb.gwu.edu/smhs_crl_facpubs/104
This Report is brought to you for free and open access by the Clinical Research and Leadership at Health Sciences Research Commons. It has been
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Authors
Barbara Gage, Roberta Constantine, Jyoti Aggarwal, Melissa Morley, Vera Kurlantzick, Shulamit Bernard,
Dianne Munevar, Megan Garrity, Laura Smith, Dan Barch, Anne Deutsch, Trudy Mallinson, and Linda
Ehrlich-Jones
This report is available at Health Sciences Research Commons:https://hsrc.himmelfarb.gwu.edu/smhs_crl_facpubs/104
August 2012
The Development and Testing of the Continuity
Assessment Record and Evaluation (CARE) Item Set:
Final Report on the Development of the CARE Item Set
Volume 1 of 3
Prepared for
Judith Tobin, P.T., M.B.A.
Centers for Medicare & Medicaid Services
Office of Clinical Standards and Quality
Mail Stop S3-02-01
7500 Security Boulevard
Baltimore, MD 21244-1850
Prepared by
Barbara Gage, PhD
Roberta Constantine, PhD
Jyoti Aggarwal, MHS
Melissa Morley, PhD
Vera G. Kurlantzick, MS
Shulamit Bernard, PhD
Dianne Munevar, MPP
Megan Garrity, BA
Laura Smith, PhD
Dan Barch, MS
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709
Anne Deutsch, RN, PhD, CRRN
Rehabilitation Institute of Chicago
Trudy Mallinson, PhD, OTR/L, NZROT
University of Southern California
Linda Ehrlich-Jones, PhD
Rehabilitation Institute of Chicago
RTI Project Number 0209853.004
The Development and Testing of the Continuity Assessment Record and Evaluation
(CARE) Item Set:
Final Report on the Development of the CARE Item Set

Volume 1 of 3
Authors: Barbara Gage, PhD
Roberta Constantine, PhD
Jyoti Aggarwal, MHS
Melissa Morley, PhD
Vera G. Kurlantzick, MS
Shulamit Bernard, PhD
Dianne Munevar, MPP
Megan Garrity, BA
Anne Deutsch, PhD
Trudy Mallinson, PhD
Linda Ehrlich-Jones, PhD
Laura Smith, PhD
Dan Barch, MS
Project Director: Barbara Gage, PhD
Federal Project Officer: Judith Tobin, PT, MBA
RTI International
CMS Contract No. HHSM-500-2005-00291
August 2012
This project was funded by the Centers for Medicare & Medicaid Services under contract no.
HHSM-500-2005-00291. The statements contained in this report are solely those of the authors
and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid
Services. RTI assumes responsibility for the accuracy and completeness of the information
contained in this report.
_________________________________
RTI International is a trade name of Research Triangle Institute.
Acknowledgments
RTI would like to acknowledge the contributions of the many organizations and
individuals who made this work possible:
Thank you for the valuable input of the many Technical Experts and associations that
made recommendations for the standardized item set.
RTI would like to thank the following professional associations for their participation in
the many discussions to develop a useful approach for standardizing assessment items across the
five levels of care. The associations also worked with their members to participate in this
national data collection. Participation in a demonstration always increases the clinician’s work
as they continue to treat their patients and provide valuable feedback to the demonstration team.
American Health Care Association (AHCA)
American Hospital Association (AHA)
Acute Long Term Hospital Association (ALTHA)
American Medical Rehabilitation Providers Association (AMPRA)
Commission on the Accreditation of Rehabilitation Facilities (CARF)
The Joint Commission (JCAHO)
Leading Age (Formerly the American Association of Homes and Services for the Aging)
National Association for Home Care (NAHC)
National Association of Long Term Hospitals (NALTH)
Visiting Nurse Association of America (VNAA)
RTI would also like to thank the many individuals at the Centers for Medicare &
Medicaid Services and the Office of the Assistant Secretary for Planning and Evaluation who
provided feedback throughout the data development, collection, and analysis process. Their
input has been invaluable in considering the wide-ranging issues from many perspectives,
including those related to Medicare research, payment, quality monitoring, and survey and
certification. The interdisciplinary and interdepartmental involvements have been invaluable in
considering data collection and analysis across the five levels of care, including the acute
hospitals, long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities,
and home health agencies. Thanks to:
Traci Archibald, Lori Anderson, Ellen Berry, Susan Bogasky, Suzanne Bosstick, David
Bott, Carol Blackford, Douglas Brown, William Buczko, Craig Caplan, Kristine Chu, Philip
Cotterill, Laurie Feinberg, Shannon Flood, Sarah Fogler, Peter Hickman, Melissa Hubert,
Jeanette Kranacs, Alexandre Laberge, Sheila Lambowitz, Jesse Levy, Shari Ling, Stella Mandl,
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Ann Meadow, Renee Mentnech, Susan Miller, Curt Mueller, Mary Pratt, Mary Beth Ribar,
Judith Richter, Abigail Ryan, Jean Scott, Susanne Seagrave, Misha Segal, Dorothy Shannon,
Kimberly Skellan, Judith Tobin, Fred Thomas, Randy Throndset, and Kathleen Walch. Thank
you to Patty Foly and her colleagues at Edward Hospital, and Carol Gouty at Rush Copley.
And thanks to our many colleagues across the RTI team, including our colleagues from
the Rehabilitation Institute of Chicago, the Visiting Nurse Service of New York, and the
University of Pennsylvania. Thank you, Dr. D. Saliba, Dr. M. Stineman, Dr. P. Murray, and Dr.
Murtaugh.
Our colleagues provided invaluable assistance with training, helpdesk activities, and
other important inputs needed to complete this data collection successfully.
Thank you to all the individuals who contributed to this important national effort.

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CONTENTS SUMMARY
This document represents Volume 1 of 3 of the final report, The Development and
Testing of the Continuity Assessment Record and Evaluation (CARE) Item Set. This project was
conducted by RTI International under contract with the Centers for Medicare & Medicaid
Services. The report is divided into three volumes.
• Volume 1: Final Report on the Development of the CARE Item Set
Executive Summary
◦
Section 1: Introduction
◦
Section 2: Study Purpose and Methods
◦
Section 3: CARE Item Justifications and Supporting Literature
◦
Section 4: Technical Expert Panels
◦
Section 5: CARE Item Set Pilot Tests
◦
Section 6: OMB Comments and Resulting Changes to CARE Item Set
◦
Section 7: The CARE Item Set: Potential Challenges and Future Enhancements
◦
References
◦
Appendices
◦
• Volume 2: Final Report on Reliability Testing
Executive Summary
◦
Section 8: Introduction
◦
Section 9: Inter-rater Reliability Testing of the CARE Item Set
◦
Section 10: Video Reliability Testing of the CARE Item Set
◦
Section 11: Functional Status Internal Consistency and Item Level Analysis
◦
References
◦
Appendices
◦
• Volume 3: Final Report on CARE Item Set and Current Assessment Comparisons
Executive Summary
◦
Section 12: Introduction
◦
Section 13: IRF-PAI–CARE Comparisons
◦
Section 14: MDS 2.0–CARE Comparisons
◦
Section 15: OASIS-B–CARE Comparisons
◦
Section 16: Conclusions
◦
References
◦
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CONTENTS
EXECUTIVE SUMMARY .............................................................................................................1
ES.1 Background ....................................................................................................................1
ES.2 Study Methods and Development of the CARE Item Set..............................................2
ES.2.1 Stakeholder Input ..................................................................................................2
ES.2.2 Defining the Domains ...........................................................................................3
ES.2.3 Forming Clinical Workgroups ..............................................................................4
ES.2.4 Selecting Items for Use in the CARE Item Set .....................................................4
ES.3 CARE Item Set Organization and Justifications ............................................................6
ES.3.1 Administrative Items .............................................................................................7
ES.3.2 Admission Information Items ...............................................................................7
ES.3.3 Current Medical Information Items .......................................................................7
ES.3.4 Cognitive Status, Mood, and Pain Items ...............................................................7
ES.3.5 Impairment Items ..................................................................................................8
ES.3.6 Functional Status Items .........................................................................................8
ES.3.7 Overall Plan of Care/Advance Care Directive Items ............................................9
ES.3.8 Discharge Status Items ..........................................................................................9
ES.3.9 Discontinued Item Subsets: Engagement Items ..................................................10
ES.4 Technical Expert Panels ...............................................................................................10
ES.4.1 Technical Expert Panel One Proceedings ...........................................................10
ES.4.2 Technical Expert Panel Two Proceedings ..........................................................10
ES.5 CARE Item Set Pilot Testing .......................................................................................11
ES.6 Office of Management and Budget Paperwork Reduction Act Review
Comments ....................................................................................................................12
ES.7 The CARE Item Set: Potential Challenges and Future Enhancement .........................13
ES.8 Conclusions ..................................................................................................................13
SECTION 1 INTRODUCTION ....................................................................................................15
SECTION 2 STUDY PURPOSE AND METHODS .....................................................................19
2.1 Overview of the Project ...............................................................................................19
2.1.1 Building on the Current Scientific Knowledge ...................................................20
2.1.2 Use of a Flexible Electronic Instrument .............................................................20
2.1.3 Gaining Stakeholder Input Throughout the Process ...........................................21
2.2 Study Methods .............................................................................................................22
2.2.1 Defining the Domains .........................................................................................22
2.2.2 Forming Clinical Workgroups ............................................................................22
2.2.3 Pilot Tests............................................................................................................23
2.2.4 Public Comment..................................................................................................23
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SECTION 3 CARE TOOL ITEM JUSTIFICATIONS AND SUPPORTING
LITERATURE ......................................................................................................................25
3.1 Administrative Items ....................................................................................................26
3.2 Admission Information ................................................................................................28
3.3 Current Medical Items .................................................................................................29
3.3.1 Primary Diagnosis and ICD-9-CM Codes ..........................................................29
3.3.2 Other Diagnoses, Comorbidities, and Complications .........................................31
3.3.3 Procedures (Diagnostic and Therapeutic Interventions) .....................................32
3.3.4 Treatments...........................................................................................................32
3.3.5 Medications .........................................................................................................36
3.3.6 Allergies and Adverse Drug Reactions ...............................................................36
3.3.7 Skin Integrity: Pressure Ulcers and Major Wounds ...........................................36
3.3.8 Physiologic Factors .............................................................................................37
3.4 Cognitive Status, Mood, and Pain Items ......................................................................39
3.4.1 Comatose.............................................................................................................39
3.4.2 Brief Interview for Mental Status .......................................................................39
3.4.3 Confusion Assessment Method ...........................................................................45
3.4.4 Behavioral Signs and Symptoms ........................................................................46
3.4.5 Mood ...................................................................................................................46
3.4.6 Pain .....................................................................................................................47
3.5 Impairment Items .........................................................................................................47
3.5.1 Bladder and Bowel Management ........................................................................47
3.5.2 Swallowing .........................................................................................................50
3.5.3 Hearing, Vision, and Communication Comprehension ......................................50
3.5.4 Upper Extremity Range of Motion .....................................................................51
3.5.5 Weight-bearing ...................................................................................................51
3.5.6 Grip Strength .......................................................................................................51
3.5.7 Respiratory Status ...............................................................................................51
3.5.8 Endurance ...........................................................................................................52
3.5.9 Mobility Devices and Aids Needed ....................................................................52
3.6 Functional Status ..........................................................................................................52
3.6.1 Core Function Items: Self-care and Functional Mobility ...................................52
3.6.2 Functional level ...................................................................................................54
3.7 Engagement..................................................................................................................56
3.8 Frailty/Life Expectancy ...............................................................................................56
3.9 Overall Plan of Care/Advance Care Directives ...........................................................59
3.10 Discharge Status...........................................................................................................59
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