Identification of Re-assessment Intervals to Support a Measurement Based Care (MBC) approach with the interRAI Community Mental Health (CMH) Assessment

Abstract

Background: Mental health is a fundamental aspect of people’s health and is a leading cause of disability worldwide. Ineffectively treated mental health problems could result in a shorter life expectancy as a result of death by suicide or serious health problems. These could be improved with a proper treatment plan based on results from systematic assessments. Measuring quality of care is challenging worldwide and varies among organization due to the absence of standardize instruments and lack of ability to regularly collect data within the health care settings. The potential use of the interRAI Community Mental Health (CMH) assessment, as a measurement based care (MBC) instrument, generates data that help to adjust the care planning and resource allocation based on the identified changes in the client’s strengths, preferences, and need. However, further research is needed to identify the optimal re-assessment interval from the initial interRAI CMH assessment. Objective: This thesis investigated the relationship of time between initial assessment and re-assessment with rates of change in clients’ needs. Methods: This retrospective study used secondary data from interRAI CMH assessments completed on clients in Ontario, Canada between 2007 and 2020, which are stored on the interRAI Canada server at the University of Waterloo. A variety of statistical techniques were used to identify the shortest period of re-assessment time to see the meaningful rate of changes. Results: This study showed that DSI and PSS-Short scales are valid and reliable over time. The highest rate of change of 75.9% for the DSI was among clients who have been re-assessed within 3-6 months. On average, the rate of change for the DSI was 73.6. The most noticeable rate of change for the PSS-short scale was for clients who have been re-assessed after 6 months: 28.2% between 6-9 months, 25.9% between 9-12 months, and 27.6% after 12 months or more. On average, the rate of change for the PSS-short was 22.7%. The most noticeable rate of change of 14.8% for the traumatic life events CAP was for clients who have been re-assessed after 12 months or more. On average, the rate of change for the traumatic life events CAP was 10.9%. The best rate of improvement (46.7%) after the initial assessment were between 6-9 months and 9-12 months. The period of time when clients worsen their initial score to 20.0% was after 12 months from the initial assessment. Conclusion: Through a thorough analysis of the dataset, this study confirmed that existing re-assessment period of 6 month is appropriate. Understanding the benefits of MBC, specifically the interRAI instruments, in CMH settings makes decision makers to apply standardized measurement instruments to the service delivery to improve quality of care, healthcare outcome, to achieve clients’ goals at the end of the treatment, and to help clinicians to monitor clients’ treatment progress and address their changes appropriately by observing the symptoms on a regular basis.