Standardized assessment of cognitive function of post-acute care patients

Victoria Shier; Maria O Edelen; Tara L McMullen; Sangeeta C Ahluwalia; Emily K Chen; Sarah E Dalton; Susan Paddock; Anthony Rodriguez; Cathy D Sherbourne; Stella Mandl; Teresa Mota; Debra Saliba

doi:10.1111/jgs.17652

Standardized assessment of cognitive function of post-acute care patients

J Am Geriatr Soc. 2022 Apr;70(4):1001-1011. doi: 10.1111/jgs.17652. Epub 2022 Mar 2.

Authors

Victoria Shier¹, Maria O Edelen^{2

3}, Tara L McMullen⁴, Sangeeta C Ahluwalia^{5

6}, Emily K Chen⁷, Sarah E Dalton⁵, Susan Paddock⁸, Anthony Rodriguez², Cathy D Sherbourne⁵, Stella Mandl⁹, Teresa Mota¹⁰, Debra Saliba^{5

11

12}

Affiliations

¹ Leonard D. Schaeffer Center for Health Policy & Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.
² RAND Corporation, Boston, Massachusetts, USA.
³ Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA.
⁵ RAND Corporation, Santa Monica, California, USA.
⁶ UCLA Fielding School of Public Health, Los Angeles, California, USA.
⁷ RAND Corporation, Arlington, Virginia, USA.
⁸ NORC at the University of Chicago, Chicago, Illinois, USA.
⁹ Division of Health Care Financing, Department of Health and Human Services, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA.
¹⁰ Abt Associates, Cambridge, Massachusetts, USA.
¹¹ UCLA Borun Center, Los Angeles, California, USA.
¹² Los Angeles VA GRECC, Los Angeles, California, USA.

PMID: 35235208
DOI: 10.1111/jgs.17652

Abstract

Background: The assessment of cognitive function in post-acute care (PAC) settings is important for understanding an individual's condition and care needs, developing better person-directed care plans, predicting resource needs and understanding case mix. Therefore, we tested the feasibility and reliability of cognitive function assessments, including the Brief Interview for Mental Status (BIMS), Confusion Assessment Method (CAM©), Expression and Understanding, and Behavioral Signs and Symptoms for patients in PAC under the intent of the IMPACT Act of 2014.

Methods: We conducted a national test of assessments of four standardized cognitive function data elements among patients in PAC. One hundred and forty-three PAC settings (57 home health agencies, 28 inpatient rehabilitation facilities, 28 long-term care hospitals, and 73 Skilled Nursing Facilities) across 14 U.S. markets from November 2017 to August 2018. At least one of four cognitive function data elements were assessed in 3026 patients. We assessed descriptive statistics, percent of missing data, time to complete, and interrater reliability between paired research nurse and facility staff assessors, and assessor feedback.

Results: The BIMS, CAM©, Expression and Understanding, and Behavioral Signs and Symptoms demonstrated low rates of missing data (less than 2%), high percent agreement, and substantial support from assessors. The prevalence of Behavioral Signs and Symptoms was low in our sample of PAC settings.

Conclusion: Findings provide support for feasibility of implementing standardized assessment of all our cognitive function data elements for patients in PAC settings. The BIMS and CAM© were adopted into federal Quality Reporting Programs in the fiscal year/calendar year 2020 final rules. Future work could consider implementing additional cognitive items that assess areas not covered by the BIMS and CAM©.

Keywords: IMPACT Act of 2014; cognitive function; post-acute care; standardization.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Cognition
Humans
Reproducibility of Results
Skilled Nursing Facilities*
Subacute Care*

Grants and funding

HHSM-500-2013-13014I/Centers for Medicare and Medicaid Services