West Virginia Senior and Disabled Assessment Pilot Project Summary
September 2000-September 2001

Executive Summary

The West Virginia Health Care Authority (WVHCA) completed the first year of a pilot project in several West Virginia counties to evaluate the appropriateness of a unique, computerized assessment tool for West Virginia’s senior and disabled populations. The project stemmed from West Virginia’s need to embrace a uniform assessment tool for entry into the long-term care system as identified by the Interagency Long Term Care Panel.

The computerized assessment tool, the Senior and Disabled Persons Assessment Coupler (SADPAC), was developed by the PKC Corporation (Problem Knowledge Coupler), Burlington, Vermont. The instrument is a data capture and clinical guidance software system that provides decision and management support to health care providers. A parallel benefit is that it couples unique patient information with evidence-based medical and social science knowledge to guide clinical decision making, care planning and care management.

WVHCA collaborated with three state agencies, the Bureau of Senior Services, Bureau for Medical Services and the Office of Health Facility Licensure and Certification, and the West Virginia Medical Institute, to oversee and implement the project. The pilot included three types of home care services - home health agencies, case management agencies and county senior programs. The goal of this project was to expand the application of the senior and Disabled Persons Assessment Coupler and other couplers across the spectrum of services to build the necessary bridges between the acute and long term care systems.

The results and recommendations from this project summary provide long term care policy makers with information to assist them in establishing a long term care system that (1) provides for the efficient communication of confidential information among care providers and (2) enhances clinical decision making to improve the quality of care delivered to each individual.

Project Summary

In 1996 the West Virginia Interagency Long Term Care Panel (ILTC) was formed to review issues relating to long term care for West Virginia’s elderly and disabled population. Task forces were formed to address specific issues, including the Universal Assessment Task Force. After several functional and technical evaluations of the PKC Senior and Disabled Persons Assessment Coupler, the Panel authorized the West Virginia Health Care Authority to underwrite a pilot project in September 2000 to evaluate its use in the state. Initially twelve pilot sites were selected including four home health agencies, four case management agencies and four county senior programs.

Five objectives were identified for the project.

1. Provide point-of-care tools to assess the current health status, psychosocial, preventive care, social service, and risk profiles of West Virginia’s senior and disabled populations in a comprehensive manner.
2. Assist in the determination of medical eligibility by recommending a level of care and insuring the most appropriate plan of care for Medicaid Waiver services.
3. Produce electronically retrievable data for statewide analysis, comparison of populations and services across populations, aggregate reporting for outcome studies, resource management, and long range strategic planning.
4. Provide a method of electronically communicating the health care information of a client among health care providers for the efficient delivery of services across the continuum of care.
5. Provide access to additional coupler technology to enhance clinical decision-making, diagnosis and management of conditions common to individuals with chronic illness.

Partnering agencies included the Central West Virginia Aging Services, Inc.; Health Consultants Plus; Potomac Highlands Support Services; Coordinating Council for Independent Living; Kanawha Valley Senior Services; Pride in Logan County; Wood County Senior Citizen’s Association; Putnam County Aging; Thomas Home Health; Care Partners; ServCare; and Grafton-Taylor County Health Department. All agencies, with the exception of Grafton-Taylor County Health Department and ServCare, completed the pilot project.

Agency registered nurses and social workers conducted the assessments on regularly scheduled visits with senior or disabled persons. Participating agencies were provided laptops, software, training and technical support to conduct the assessments by both the West Virginia Health Care Authority and PKC. WVHCA also installed additional support software to facilitate communication among PKC, the agencies and WVHCA. Throughout the implementation process PKC supplied comprehensive client support services for all the agencies.

Ten of the original 12 agencies excelled in contribution to the goal of designing a common and standardized set of assessment instruments and processes for entry into West Virginia’s long term care system. Agencies were asked to complete at least twenty-five sessions. Two home health agencies withdrew from the project due to nursing staff shortages. A total of 1251 sessions were completed by the agencies.

Each month the WVHCA and PKC held teleconference meetings with each of the participating agencies to discuss project issues, concerns or implementation challenges. The following table identifies several of the issues raised and their resolution:

Findings from a July 2001 Agency User satisfaction survey indicated two-thirds of the agencies completed the Senior and Disabled Persons Assessment Coupler in one to two hours, more than half of the agencies completed over 50 assessments, and eighty-three percent of the agencies supported implementation of the project within their agency and within the state. Findings from an August 2001 customer satisfaction and perception survey, within a 30% response rate, indicated patients and staff liked the assessment, believed their care was improved because of the use of the assessment, and were acceptable to the use of time needed to complete the assessment.

One project purpose included enhancing the efficiency and functionality of administrative forms. PKC developed an automated version of a case management agency form used to determine eligibility for Medicaid, Medicare and aging government-sponsored programs. This included a refinement of the comprehensive integrated assessment instrument, activities of daily living rating scale, and the inclusion of a federally-required home health report.

Data collected by the pilot project covered several purposes, to include improving the health status of West Virginians. Six hundred forty-five assessments were completed on 615 patients. Four hundred fifty participants over the age 65 were female. Most participants were widowed or single.

Data analysis included a total of 52 different health variables, with between two and 497 responses for each variable category. The number of participants included in each level of analysis ranged from 450 to 645.

Project participants were assessed for risk factors that could place them at risk of preventable illness or death. These factors included repeat hospitalizations, overweight or obesity, geriatric depression, hypertension, smoking, and alcohol use. Each individual received a Pra Score (Probability of Repeat Hospital Admissions), and was identified as either low or high risk. Over 66% of the assessed patients were identified as at-risk of a repeated hospital admission, compared to 25.2% in a national Medicare study.

Other project participant study findings included identifying over 50% as obese, over 40% as depressed, over 40% having coronary artery disease, nearly 60% as taking blood pressure medications, and over 30% as diabetic.

Of the five project objectives, Numbers 1, 2 and 5 were met, objective 3 was partially met, and objective 4 was deferred until the WVHCA developed a procedure to ensure the secure transmission of data.

Results of the West Virginia pilot project support the development and expansion of a statewide project. To support this expansion, input, coordination and communication from many state agencies and community-based agencies involved in long term care will be needed. Expansion is recommended at the regional level. The following recommendations to develop a single point of entry for long term care services are based on the learning experiences, input and feedback for the agencies involved in the first year of the pilot project.

Recommendations at the State level include:

• Identify and eliminate duplicated data elements required by State-agency assessments.
• Identify the technical infrastructure and technical needs to insure full functionality and use of the couplers through a web-based platform.
• Use the available Problem-Knowledge Couplers to manage chronic health care conditions.
• Develop and maintain a fully functional, accessible and secure central repository of all Coupler session data.
• Use data obtained in the central repository to standardize statewide data collection activities, analyze and develop outcome studies, profile populations and develop policies.

Recommendations at the regional level include:

• Develop a single entry point for long term care services.
• Develop a common intake tool for long term care services.v
• Include all providers responsible for the screening and management of older persons and younger persons with disabilities.
• Identify current coupler experts to train others in using the couplers.
• Share coupler data across providers, including providers outside of long term care, to reduce redundancy in data entry, collection and assessment.
• Use the care management couplers to manage chronic conditions, adapt the best standards of practice and evidence based recommendations.

West Virginia was attracted to the Senior and Disabled Persons Assessment Coupler because of its ease of use, comprehensiveness and ability to collect information at the point of care. Statewide implementation is recommended to assure individuals applying for long term care services in West Virginia receive a standard assessment and evaluation and the same opportunities and choices for their care. It will also reduce inappropriate placements and insufficient care and improve the quality of care provided to the elderly and disabled .Elimination of a paper-based data collection system will promote economies of effort and cost. The project’s centralized database assures continuity of care when an individual changes a service provider.

Through the statewide use of the Problem Knowledge Couplers, Home and Community-based agencies will be able to transform the delivery of care by relying on standardized data to guide agency decisions to plan for care, improve their care, identify high risk patients and provide data for required federal and state reporting. At the state level, the project’s database will provide insight to information to assist policymakers in identifying areas of the state that are over- or underserved. The Medicaid Program will have more accurate information for rate settings and researchers can identify areas of the state where medical problems are more prevalent so that programs can be designed to improve the health of West Virginians.

In conclusion, the majority of the project objectives were met and there was overall user and patient satisfaction with the tool. Both the WVHCA and PKC Corporation recommend statewide expansion with regional deployment.

A copy of the 53 page Project Summary is available by clicking here.