InterRAI

Screening Algorithms

Growing demand for long- term services and supports increases the need to identify and prioritize target populations so that scarce resources can be allocated fairly and equitably.  The ability to support systematic, standardized methods for such activities is one of the most important benefits of interRAI assessment systems.  interRAI has worked with various governments to design and test screening tools that measure relative urgency of services need or overall care complexity.  The algorithms can be run using a limited set of interRAI items, thus making efficient use of limited agency resources.  Two such screeners derived from the interRAI Home Care system are described below.

MAPLe (Method for Assigning Priority Levels)

MAPLe differentiates service seekers/clients into five priority levels, based on their risk of adverse outcomes. Clients in the lowest priority level have no major functional, cognitive, behavioral, or environmental problems and are considered self-reliant. The highest priority level is based on presence of ADL impairment, cognitive impairment, wandering, behavior problems, and the interRAI nursing home risk CAP. Research has demonstrated that the five priority levels are predictive of risk: Individuals in the highest priority level are nearly nine times more likely to be admitted to a long- term care facility than are the lowest priority clients. MAPLe also predicts caregiver stress. Diagram. A version of MAPLe suitable for use in hospital has also been validated.

MI Choice

MI Choice is a brief screening tool that groups individuals in one of five categories: nursing home, home care, intermittent personal care, homemaker, and information and referral. The screen can be used over the phone to identify persons who are not likely to meet health, cognitive, and functional criteria for home care or institutional services. This enables expensive in-person assessment resources to be targeted to persons who are screened as more likely to qualify as medically eligible for assistance. During the assessment process, MI Choice can also serve as a complement to the assessor's clinical insights and the individual's preferences about the most appropriate care setting. Diagram

References

Bjorkgren MA, Fries BE, Shugarman LR. 2000. Testing a RUG-III Based Case-Mix System for Home Care. Canadian Journal on Aging 19 (Supplement 2): 106–25.

Fries BE, James M, Hammer SS, Shugarman LR, Morris JN. 2004. Is Telephone Screening Feasible? Accuracy and Cost-Effectiveness of Identifying People Medically Eligible for Home- and Community-Based Services. Gerontologist 44(5): 680–88.

Fries BE, Shugarman LR, Morris JN, Simon S, James M. A Screening System for Michigan's Home and Community-Based Long-Term Care Programs. Gerontologist 42(4): 462–74.

Hirdes JP, Poss JW, Curtin-Telegdi N. 2008. The Method for Assigning Priority Levels (MAPLe): A New Decision-Support System for Allocating Home Care Resources. BMC Medical Informatics and Decision Making 6: 9.

Noro A, Poss J, Hirdes J, Fine-Soveri H, Ljunggren G, Bjornsson J, Schroll M, Jonsson P. 2011. Method for Assigning Priority Levels in Acute Care (MAPLe-AC) Predicts Outcomes of Acute Hospital Care of Older Persons — a Cross-National Validation. BMC Medical Informatics and Decision Making 11(1).