PowerPoint Presentationfiles.constantcontact.com/f401fd14401/79eb4086-9318-40cc-b96c-d1b... ·...

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An Introduction to the HRST

Introductions

Sherry Neal, RN-BC, CDDN Director of Clinical Services

David M. Toback, MADirector of Client Services

Group Activity

1. Find a partner, preferably someone you don’t know

2. You will have 1 minute to introduce yourself AND observe your partner closely

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What is the HRST?

A web-based instrument developed to screen

for health risks associated with:

• Intellectual/Developmental Disabilities

• Physical Disabilities

• Disabilities Associated with Aging

• Traumatic Brain Injury

• Any Vulnerable Population

The History of the HRST

• Developed in 1992 – federal lawsuit

• Known originally as “Physical Status Review” (PSR)

• Extensively field tested on 6000 individuals

• Used in numerous states

• Web-based version released in 2006

The Importance of Health Risk Screening in the I/DD Community

• Serving those with I/DD in the community is a new endeavor

• Early detection and action saves lives!

• Quality of life is directly related to quality of health

• Those who serve the person most directly often have little to no training on identifying the emergence of health related risk or destabilization

• Major signs of risk can go unappreciated or masked by I/DD attributes, such as an inability to communicate

• Poly-pharmacy dynamics in the community

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The HRST is a SCREENING Instrument

• Should not be confused with a more in-depth assessment process

• Can be used to determine what types of further assessment or evaluation might be required

• Developed for use by non-licensed staff, such as case managers, program staff, or direct care staff

• Nursing oversight is triggered when necessary

How does the HRST work?

The HRST is a simple 22 item scale designed to find out which individuals are at most risk of illness and health

destabilization.

The tool then responds by producing action steps that empower support staff in the form of special

attention and prevention.

The HRST Categories and ItemsI. Functional Status

A. Eating

B. Ambulation

C. Transfer

D. Toileting

E. Clinical Issues

II. Behaviors

F. Self-Abuse

G. Aggression

H. Physical Restraint

I. Chemical Restraint

J. Psychotropic Meds

III. Physiological

K. GastrointestinalL. SeizuresM. Anti-Epileptic MedsN. Skin IntegrityO. Bowel FunctionP. NutritionQ. Treatments

IV. Safety

R. InjuryS. Falls

V. Frequency of Service

T. Professional Health Care ServicesU. ER VisitsV. Hospitalizations

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The HRST Health Care Level

Level 1: 0 - 12 Points





Level 6: 69 or greater

Low Risk

High Moderate Risk

Highest Risk

Moderate Risk

High Risk

Transforming Data Into Action !

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The HRST In Action: The Service and Training

Considerations

Service Consideration Example

• Service Consideration:• Nutrition/Clinical Dietician section

• Item: (K) Gastrointestinal

• Score: 4

• Consideration: Nutritional/clinical dietician assessment to determine which elements of current diet are contributing to GI signs & symptoms

Training Consideration Example

• Training Consideration:• Signs/Symptoms/Emergencies section

• Item: (S) Falls

• Score: 4

• Consideration: Provide the caregiver with training about recognizing and responding to signs and symptoms of a serious injury arising from a fall

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The Importance of the Considerations

The Power to Act!

Observe: The screening process reveals areas of risk and

destabilization

Decide: The intensity of the scores allow you to easily

decide where attention should be focused

ACT: The Considerations give you action steps to

respond

The Considerations and the Person

• It is where the HRST and the person intersect!

• If the HRST is going to save a life, have any impact on the person or their quality of life, it will mainly be because the team acted on the Considerations.

• We know this because the majority of our success stories come from users who have implemented the Considerations.

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• Allow caregivers to be informed and responsive to the individual’s needs

• Enhance service delivery because now you know how to respond

• Assists in the development of health and safety sections of yearly individual plans

• Points out service and training needs that are less than obvious

• Gives the family and staff talking points while visiting with health care professionals

• Serve as a troubleshooting guide for caregivers

Helps avoid preventable deaths!!

Primary Uses of the Considerations

The next Service and Training Considerations webinar…

Attend our next FREE webinar on Tuesday April 4, 2017 from 1:00 pm – 2:20 pm EST The

registration link is-

https://attendee.gotowebinar.com/register/3674081155369675266

Questions?

https://attendee.gotowebinar.com/register/3674081155369675266

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IMPROVING RATER ACCURACY

Common Pitfalls

Objectives

• Become skilled at making appropriate comments

that support rating scores

• Identify common rater errors and learn how to avoid them

• Learn how to correct the common rater errors

• Make sure all diagnoses are accounted for

• It is best practice to add comments to all diagnoses regarding severity, symptoms experienced by that person, treatments for the conditions and the effect on the person’s life

• Make notes and comments about what should be accounted for in the ratings section

Review the Diagnoses Section

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• Not specifically diagnosed by a health care provider

• Still should have appropriate supporting comments

• Make notes about what should be accounted for in the ratings section

What is an undiagnosed condition?

• Be included with EACH diagnosis

• They often help in determining appropriate rating

• Give person-specific information

• Two people with the same diagnosis may have VERY different presentations or severity

• Be updated as the diagnosis evolves or changes• This is a good way to track the progress of

chronic diagnoses over time

Diagnosis Comments Should:

• Onset date

• Date of resolution

• Correct use of ‘Unknown’

Diagnosis Onset and Resolved Dates

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• Make sure all medications are accounted for • Include all meds taken within the past year

• Enter PRN medications ONLY if actually taken in last year

• Medications given during ER visits and hospitalizations

Review the Medications Section

• Six designated by the HRST: • PSYCHOTROPIC

• ANTI-EPILEPTIC

• GASTROINTESTINAL

• BOWEL

• EMERGENCY DRUG/CHEMICAL RESTRAINT

• Other

Medication Purpose

Medication Entry Errors

• Purpose should be • Incorrect “other” entry

3. Emergency Drug 3. PRN sleep, anxiety, prior to dental/MD

1. Anti-Epileptic 1. Seizures, epilepsy, Lennox-Gastaut

2. Bowel 2. Constipation, hard stool, diarrhea

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• Complete at least 1 Clinical Review within the next 30 days

• After completion, send a clinical support ticket indicating the name of the individual reviewed and the state/agency you are in/with

• Clinical Director will then review and make any necessary comments to help improve your reviews!

What Next?Medication Entry Errors

4. Psychotropic 4. Anxiety, ADHD, dementia, depression

5. Gastrointestinal 5. GERD, heartburn, Crohn’s disease

• Selecting correct Med Purpose

• Entering specific indication in the comments or diagnosis section

• Provide training to staff to enter correctly. Remember, non-clinical staff may not know what medications are for

Correct this error by

• Start date

• End date

• Correct use of ‘Unknown’

Start and End Dates of Medications

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• Use caution when selecting UNKNOWN:• For the diagnosis resolve date

• For the medication end date

• What people think it means:• I don’t know when the diagnosis will resolve or

the medication will be discontinued

• What it really means:

• The diagnosis was resolved or the medication discontinued on a date that I don’t know

Correct Use of UNKNOWN

• Dosage

• Units

• Route of administration

• Frequency

• Specific diagnosis

Medication Information Should Include:

• It can affect ratings on Items I, J, K, M, O, Q- NUMBER of meds being taken

- Any medication changes within the past year

• Correct purpose allows tracking of usage of certain types of medications

• Use medications from drop down list if at all possible

Why is medication entry so important?

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Bowel: Group Discussion

How can things related to BOWEL affect an individual’s quality of life and quality of

health?

O. Bowel Function

• Bowel obstruction and/or impaction can be a frequent killer of special needs individuals who live in community settings

• This item rates the amount of intervention needed to maintain normal bowel function

• Bowel function is affected by• Diet

• Activity level

• Medications

• Genetics• Many other things

The GI Tract

With bowel we are more concerned with the ‘product’, not the ‘process’

Right Left

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What Kinds of Bowel Issues Should I Be Aware Of?

• Constipation

• Small or Large Bowel Obstructions

• Paralytic Ileus (stopping of peristalsis)

• Fecal Impactions

What do you need to know to score Item O. Bowel accurately?

• History of bowel obstruction or ileus

• Diet modification for constipation

• Number and types of medications being taken for bowel purposes

• Need for suppositories or enemas

• Any hospitalization related to bowel issues

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Bowel Function Scoring Descriptors

0. No interventions of any kind needed

1. High fiber foods, additional fluids or other dietary changes needed for normal function

2. Use of a single fiber supplement or stool softener

3. Use of more than one supplement or any medication that impacts bowel function

4. Hospitalization in the past year for impaction or at any time in past for bowel obstruction or ileus

Common Errors

1. Not identifying specific dietary interventions (i.e. it is written that individual has dietary changes in place but no other information is listed).

2. Failing to account for a bowel obstruction, regardless of how long ago it occurred.

3. Not indicating in the comment how often PRN interventions were used

Anna has had constipation for years and it was always well managed with prune juice twice a day. Anna’s score is a 1.

Now it’s your turn to write a comment that supports a score of 1…

For your reference a score of 1 on Bowel is qualified as follows:

High fiber foods, additional fluids or other dietary changes needed for normal function

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Anna recently fell and broke her shoulder and is on Vicodin PRN for pain. She takes one every night so that she can sleep because she can’t get comfortable. The prune juice is no longer working. She is taking Miralax 17 Gm in 8 ounces of water daily now and is doing fine. Her score is now a 3.


For your reference a score of 3 on Bowel is qualified as follows:

Use of more than one supplement or any medication that impacts bowel function

Nutrition: Group Discussion

How can things related to Nutrition affect an individual’s

quality of life and quality of health?

P. Nutrition

• Includes a WIDE variety of issues

• Weight issues

• Chronic health problems

• Abnormal lab values• Hospitalizations

• Prescribed diets

Does NOT include texture modifications that are rated under Item A. Eating

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Conditions Requiring Nutrition Status Monitoring:

• Diabetes

• Anemia

• Many lab values – albumin, hemoglobin, iron, electrolytes, blood urea nitrogen (BUN) (you may/may not see lab results)

• Kidney or Liver disease

• Bowel impaction or bowel obstruction

• Pressure ulcer/sore (bed sores)

• Peripheral vascular disease

Importance of Monitoring Weight

• Recommend at least monthly, but needs to be done no less than quarterly

• Weight changes

• Lifestyle, aging

• Med side-effect

• Metabolic issues

• If unplanned weight loss, always cancer until proven to be something else

• Significant weight change if 5% in 1 month, 7.5% 3 months, 10% 6 months

What do you need to know to score Item P. Nutrition?

• Current weight, current BMI and weight history for past 12 months

• Ideal body weight

• Any dietary or fluid restrictions, food allergies / intolerances or supplementation

• Prescribed diet, including tube feeding

• Chronic medical conditions

• Nutrition related labs

• Meal refusals or poor appetite

• Hospitalization that may affect nutrition

• G or J tube complications

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Item P - Nutrition

0. Within ideal body weight range and able to maintain weight

1. Is slightly above or below ideal body weight range. May require extra calories or some dietary restrictions

2. Is well managed on a prescribed diet3. Has demonstrated weight instability in the past

OR has an identified nutritional risk which required nutrition status monitoring within past 12 months

4. Nutritional status unstable within the past 12 months

Nutrition Comment ScenarioAlice has been in the hospital for pneumonia. She weighed 180 pounds 1 year ago and now weighs 150 without dieting. Her current BMI is 29.81. Her score is a 3.


Note, a score of 3 is qualified as follows –

Has demonstrated weight instability in the past OR has an identified nutritional risk which required

nutrition status monitoring within past 12 months.

Daniel is on dialysis and is on 750 ml (25 oz.)/day fluid restriction and strict renal/high caloric content diet. Continues to lose weight. Current weight is 100 pounds. BMI is 17.33. IBW is 110-135. Has continuous pressure wound on buttocks.


For your reference a score of 4 on Nutrition is qualified as follows:

High risk with an unstable nutritional status. Required intensive nutritional intervention.

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Jackson has celiac disease and is on a gluten free diet. His condition is stable. His score is a 2.

Now it’s your turn to write a comment that supports a score of 2 …

Note a score of 2 is qualified as follows:

Within desired weight range, but has a diet prescription for health maintenance or health

concerns which have been under control for the past 12 months (low sodium, low cholesterol, etc.).

• Items on the HRST are labeled A (Eating) through V (Hospitalization)

• Requirements for Licensed Intervention is Item Q

Its unusual name is a reflection of its unique status

Why is it called the Q-Score?

• Score can only be 0 or 4

• 8 point impact on the overall score

• Automatically bumps the final Health Care Level up to the next level

• May increase the overall HCL by 2 levels

• 8 extra points + automatic bump-up

Cannot be HCL 6 without it or HCL 1 with it!

A Specialized Rating Item

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• Treatments which place the person in an elevated risk category

• Tracheostomy or ventilator dependent

• Nebulizer meds or sliding scale insulin

• Catheterization, port care, etc..

• Terminal illness, acute organ system failure• Requires nursing care at least every two hours

on a 24 hour basis

• 1:1 support for behavioral purposes while awake

And Much More!

What Information Does It Capture?

• We will now take a look at each of the Q-score questions to see what they mean

• We will also discuss which related treatments or circumstances do or do not apply and why

• We will then discuss the impact or correlation with other rating items on the HRST

Breaking Them Down

The Respiratory Questions

“Within the past twelve months have they…”

1. “…had a tracheostomy that requires suction?” (for at least 14 consecutive days)

2. “…been dependent upon a ventilator?” (for at least 7

consecutive days)

3. “…required airway suction at least 6 inches into the airway OR below the voicebox?” (for at least 14

consecutive days)

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Medication-based Q-Scores:

Within the past 12 months have they…

1. …required medications that are administered via nebulizer at LEAST once per day? (for at least 7 consecutive

days)

2. …required sliding-scale insulin for diabetes?” (for at

least 14 consecutive days)

Check to see if these were administered during a hospitalization if the hospitalization was > 7 days

• “Within the past 12 months have they required the services of staff on a 1 to 1 basis for behavioral issues during waking hours (at least 16 hours per day?)” (for at least 14 consecutive days)

– One or more staff members whose job is observing and intervening with behavioral matters related to self-abuse and/or aggression

– Normally sit within arm’s length of the individual

Behavior-based Q-Score:

• If 1:1 Q-Score applies, the Item F - Self-Abuse and/or Item G -Aggression MUST be scored 4

– Due to need for enhanced staffing or supervision

• Not everyone with a score of 4 for Self-Abuse and/or aggression gets a Q-Score

– If 1:1, but not during all waking hours

– If score of 4 is not related to staffing ratio

– If enhanced staffing is not considered direct 1:1

Behavior-based…

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“Within the past 12 months have they had a condition that required hands on treatment by a nurse or equivalent professional that CANNOT be taught to non-licensed personnel?”

• Some things done by nurses don’t count here:

– Medication administration via G-tube

– Non-sterile dressing changes

• Some things done by staff, guardians or the individual themselves do count:

– Daily or more frequent catheterization

– Trach care or suction

– Peritoneal dialysis

The Trickiest Q-Score Question:

• Medication therapy requiring DAILY intramuscular or intravenous injections or hemaport irrigations one or more times daily (for at least 7 consecutive days)

• Daily or more frequent catheterization, requiring sterile technique (for at least 7 consecutive days)

• Sterile dressing/wound treatments routinely performed only in clinical settings or by licensed practitioners (for at least 14 consecutive days)

Hands on Treatment by a Nurse that CANNOT be Taught

• Physician-ordered treatments that CANNOT be delegated to a non-licensed person, such as chemotherapy or renal dialysis

• Individuals in acute and/or end stages of cardiac, liver, lung or kidney disease

• End stage terminal illness or with end stage progressive neurological disorders

• Jejunostomy tube

Hands on Treatment…

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• Item A - Ambulation

– If they require 1:1 staffing due to an elopement risk (score 1 supervision)

• Item D - Toileting

– Any catheterization (score 4 catheterization)

Correlation with Other Rating Items

• Item E - Clinical Issues Affecting Daily Life

– If prohibited from places, activities or other people due to behavioral issues

– Need for ongoing respiratory care may impact the person’s ability to participate in their usual activities of daily living

– Increased health care provider visits or treatments that interrupt activities

– Decreased participation due to not feeling well, disease progression or fatigue

Correlation…

• Item F – Self Abuse

• Item F – Aggression

• Item H – Physical Restraint

- May require physical restraint due to behavior

• Item I – Chemical Restraint

- May require chemical restraint due to behavior

- May have required during a hospitalization or ER visit

Correlation…

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• Item J – Psychotropic Medications

- Behavior severe enough to require medication interventions on a routine basis or a change to current routine medications

• Item N – Skin Breakdown

- Wounds – pressure, self-abuse,

- Diabetes, J tube, nutritional compromise related to end stage disease

- Wound clinic or hospitalization for wound treatment

Correlation…

• Item P – Nutrition

- End stage disease

- Increased nutritional needs for wound healing

- Weight loss

- J tube feedings or complications

- Diabetes

• Item R. Injuries

– If harmed by self or others (while being aggressive)

Correlation…

• Item U – Emergency Room Visits

- J tube complications

- Low blood sugars with diabetes

- Don’t count one time occurrences like a one-time nebulizer treatment

• Item V – Hospitalization

- May have been temporarily ventilator dependent or received frequent nebulizers

Correlation…

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• Overall, the HRST measures the likelihood of a negative health event or death based on the existing medical and behavioral issues

– Assigning a Q-score for routine, lower risk issues makes it appear as though the nurse performing a procedure/process places people at a higher level of risk when it is the procedure/process itself, not who performs it

Significance

• Unacceptable:

– “Gets nebulizer treatments”

– “1:1 Staffing needed”

– “Takes insulin”

– “Needs 24 hours nursing care”

– “Had cut and needed dressing changed”

Comments Matter!

• Acceptable:

– “Nebulizer treatments 2 x daily for severe asthma symptoms during allergy season for 10 days”

– “Requires 1:1 staffing during all waking hours due to rage behavior and physically striking anyone within range for 6 months while on Keppra”

– “Sliding scale insulin before meals based on capillary blood glucose since 8-2016”

– “Required wound vac for over 3 weeks after bowel resection 10-3-16/10-28-16”

Comments Matter!

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• Every state is different in terms of what they allow

• The Q-score must always capture the degree of genuine risk, regardless of what the law does or does not allow

• When in doubt, contact HRST Clinical Support @ [email protected]

It all boils down to this

A Question of Delegation

• Overall, the HRST measures the likelihood of a negative health event or death based on the existing medical and behavioral issues

• Every state is different in terms of what they allow

• The Q-score must always capture the degree of genuine risk, regardless of what the law does or does not allow

To ‘Q’ or Not to ‘Q’

Regarding her asthma/COPD - nurse indicated they do no less than monthly checks unless they are alerted to any issues.

Freddie has a diagnosis of Diabetes Type II. A sliding scale is used with him.

The dressings used to the wound on his back were not sterile, just a clean dressing and the nurse took care of it as it required skilled nursing intervention.


1. Martha's cancer was not given a stage number as treatment was not being considered. According to physician's notes, it is believed that the doctors were able to get all of the tumor. Martha's lymph nodes were not removed as it was believed that she could not handle it.

2. Shane self-administers 28 units of insulin every day at bedtime using his Flex-Pen


3. Sandra has asthma/COPD and the nurse indicated they check her monthly checks unless they are alerted to any issues.

4. Freddie has a diagnosis of Diabetes Type II. He receives insulin before meals based on his blood sugar

5. The dressings used to the wound on Steve’s back were a clean dressing and the nurse changed it because the direct support staff was busy

mailto:[email protected]

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In Summary:

• The Q-score tells who has true issues with health vulnerability

• Even relatively stable people MAY have a Q-score

• The Q-score must be consistent in ALL settings

– Bodies don’t change when we cross state lines, even if the rules do

• If you have concerns help is always available


Regarding her asthma/COPD - nurse indicated they do no less than monthly checks unless they are alerted to any issues.

Freddie has a diagnosis of Diabetes Type II. A sliding scale is used with him.

The dressings used to the wound on his back were not sterile, just a clean dressing and the nurse took care of it as it required skilled nursing intervention.


Martha's cancer was not given a stage number as treatment was not being considered. According to physician's notes, it is believed that the doctors were able to get all of the tumor. Martha's lymph nodes were not removed as it was believed that she could not handle it.

Shane self-administers Lantus insulin daily at bedtime using his Flex-Pen


6. John was scheduled for outpatient bilateral inguinal hernia surgery in the last 6 months. He had to be admitted because he couldn’t be weaned off of the ventilator for 6 days because of his underlying COPD.

7. Anita lives at home with her mother. She is on peritoneal dialysis on a cycler and mom hooks her up at bedtime and unhooks her in the morning so she can go to work.


8. Vickie has a history of breast cancer with bilateral mastectomy 2 years ago. She has a Hemaport and it is flushed monthly to maintain patency and has blood draws from it every 6 months.

9. Jason refuses to take oral medications. He was diagnosed with aspiration pneumonia and Rocephin 1 Gm was administered IM daily for 14 days.

• It is impossible to cover every contingency or discuss every situation that might qualify the person for a Q-score

• If you are uncertain of whether or not the person qualifies please contact HRST Clinical Support @ [email protected]

• We will help you determine how to score the person if you are unsure

Special Circumstances


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• Go to the appropriate screen in the Ratings area

• Click the ‘Previous Questions” button and it brings up all the questions used to ascertain the score

• The last question at the bottom of the screen is the 1st question you need to review

• Change any question needed, then click submit

• It may present you with new questions to answer

• Enter a comment explaining the reason for the change: “It has been greater than 1 year since ‘Joseph’ required nebulizer treatments.”

If the Q-score is incorrect

Thomas moved from his family home to a community setting with 2 other individuals. He started exhibiting behaviors of slapping others who come close to him. He now requires 1:1 staffing to protect his housemates and has had this staffing in place 30 days.


For your reference a score of 4 on Item Q

• “Within the past 12 months have they required the services of staff on a 1 to 1 basis for behavioral issues during all waking hours (at least 16 hours per day?)” (for at least 14 consecutive days)

• The Q-score tells who has true issues with health vulnerability

• Even relatively stable people MAY have a Q-score

• The Q-score must be consistent in ALL settings

– Bodies don’t change when we cross state lines, even if the rules do

• If you have concerns help is always available

In Summary

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• Very common rating errors

• Measures the extent to which the person’s issues impact their life

• VERY important way of accounting for issues not directly mentioned by the HRST

• Should only be zero if the person is a HCL 1

Mis-scoring Items E and T

• Based on the person’s “normal” day• Does not have to disrupt the entire day to

count• Normal may be school, day program, work,

leisure time, weekends, etc.

• Includes physician visits to identify or address any diagnosed conditions

• Blood work, prescription renewal, specialist visits

• Is simply counting the number of days the person was affected

Item E – Clinical Issues Affecting Daily Life

• Includes any health or behavioral issue that disrupts normal activities• Days when the person is ill or injured

• Days when their behavior impacts participation

• Seizures• Every hospitalization or rehab day and recovery

days

• Labs related to diagnosed conditions or medications

• Mental Health appointments or issues

• Therapies such as counseling, PT, OT, Equine, Music, Art, etc.

Item E – continued

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• Omissions due to personal choice• “I choose to be a home-maker (or to retire!)”

• “My son does not need a day program”

• Policy-driven visits or absences• All individuals see the physician at least once

per quarter because of agency policy

• When inclement weather prevents travel

• Closure of schools or places of business during observed holidays

What doesn’t count?

Carla has a seizure disorder, cerebral palsy and depression. She is on several medications. She has seen her PCP 2 x for F/U of CP, Psychiatrist 4 x, had counseling weekly x 4 weeks and saw her Neurologist 2 x. Had 4 seizures in past year and was off work with the flu for a week. She had her annual screening mammogram and a colonoscopy because she turned 50. Had dental check ups x 2. She had labs to monitor for side effects 4 x.

How many days were affected?

Do all of the visits count on Item E?

Joseph had a stroke and was in the hospital for 14 days, the nursing home for 60 days for rehab and then had outpatient P.T. for another 60 days. Sees her cardiologist for follow-up of poorly controlled HTN every month with frequent med adjustments.

How many days were affected?

Do all of the visits count on Item E?

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• Visits to/from ALL Health Care Professionals• MD/DO, visits to ANY specialist

• Psychological professionals, counselors

• Nursing, PT/OT, RT, nutritionist, diabetes educator

• DDS, DC or other independent health professionals

• Must address a diagnosed condition

• Screening visits and annual check-ups do not count!

Item T – Professional Visits

Carla has a seizure disorder, cerebral palsy and depression. She is on several medications. She has seen her PCP 2 x for F/U of CP, Psychiatrist 4 x, had counseling weekly x 4 weeks and saw her Neurologist 2 x. Had 4 seizures in past year and was off work with the flu for a week. She had her annual screening mammogram and a colonoscopy because she turned 50. Had dental check ups x 2. She had labs to monitor for side effects 4 x.

How many health care visits should be counted?

Do all of the visits count on Item T?

Joseph had a stroke and was in the hospital for 14 days, the nursing home for 60 days for rehab and then had outpatient P.T. for another 60 days. Sees her cardiologist for follow-up of poorly controlled HTN every month with frequent med adjustments.

How many health care visits should be counted?

Do all of the visits count on Item T?

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• Contains specific descriptions of the criteria for each and every score on the HRST

• Defines which treatments or issues qualify under this particular Q-score question

• Identifies what conditions have ‘permanent’ points

HRST Expanded Scoring Descriptors

• Available in the Knowledgebase section of the HRST Support Site

Help -> View Knowledgebase -> HRST Knowledgebase -> Clinical Information Folder -> Expanded Scoring Descriptors

OR:

• Click on any of the area of the rating box and the Expanded Scoring Descriptors will pop up for that particular Item

Scoring Descriptors…

HRST OutcomesWhy All This is So Important

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“The HRST allows for a proactive approach to healthcare delivery, thus minimizing the health risks to the individual.” -K.B., RN Louisiana

Source: Karen Brown, RN LA, 2006.

The HRST and Life Expectancy

• Study to show correlation between Health Care Level (HCL) and life expectancy

• Sample of over 16,000+ individuals used

• HCL on HRST was prognostic of longevity

• Significant decrease in life expectancy from a HCL of 3 and a HCL of 4

Source: Predictive Validity of a Health Risk Screening Tool Designed for People with Developmental Disabilities, Michael J. Roszkowski, Ph.D., and James W. Conroy, Ph.D. Center for Outcome Analysis. 2016.

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Health Care Level Median Age

1 81.77

2 76.96

3 75.90

4 69.36

5 68.57

6 67.14

Average Life Expectancy by

Health Care Level (Years)

Average Life Expectancy by

Health Care Level (Years)

81.77

76.9675.9

69.3668.57

67.14

50

55

60

65

70

75

80

85

1 2 3 4 5 6

Age

Healthcare Level (HCL)

Avg Life Expectancy

Mortality Rate by HRST Score

“These analyses clearly indicate that health risk, especially higher health risk scores, are significant predictors of mortality.”

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HRST OR 2013 OR 2014 OR 2015

1 1.65 1.61 1.66

2 2.72 2.60 2.77

3 4.48 4.20 4.60

4 7.39 6.77 7.66

5 12.18 10.91 12.74

6 20.09 17.60 21.20

Odds Ratio (OR) for HRST Scores, 2013 – 2015

• The odds of dying increase significantly with each one-point increase in HRST score.

• The main finding is that each one-point increase in HRST score has a very strong relationship to the likelihood that death may occur, even at the lowest levels.

Summary of Findings

• The HRST Health Care Level is prognostic of longevity (as HCL increases, longevity decreases)

• Significant drop in longevity at HCL 4

• Particular attention should be placed on those individuals at a HCL 4 or those with increasing HCL’s

• With each HCL increase, the odds of dying increase exponentially EVEN at lower Health Care Levels

• Increases in HCL’s should prompt action to avert unnecessary, preventable death

• A two-point increase in HCL significantly increases the likelihood of mortality

“The HRST has helped immensely in monitoring for unhealthy patterns that might have resulted in detrimental outcomes. People are alive today because of the HRST.” -M.W., RN Georgia

03/23/17

41

Getting Help:

• Clinical Assistance – [email protected]

– Questions about ratings, scoring, medication

• Technical Assistance –[email protected]

– Questions about access, passwords

– Computer-related difficulties

– Success stories

– Training needs

Final Group Activity

Last Man Standing



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