In the landscape of healthcare, particularly within inpatient rehabilitation facilities (IRFs), the need for standardized and effective care tools is paramount. These tools play a crucial role in ensuring consistent patient assessment, guiding treatment plans, and ultimately improving patient outcomes. One such vital instrument is the Continuity Assessment Record and Evaluation (CARE) Item Set, a standardized patient assessment tool designed to bridge the continuum of care from acute hospitals to post-acute settings, including IRFs. Understanding the CARE Item Set is essential for healthcare professionals aiming to optimize care delivery and navigate the complexities of modern healthcare payment models.
The development of the CARE Item Set was intrinsically linked to the Centers for Medicare & Medicaid Services (CMS) Post-Acute Care Payment Reform Demonstration (PAC-PRD). This initiative, spurred by the Deficit Reduction Act of 2005, sought to standardize patient information across various healthcare settings. The goal was to analyze the consistency of payment incentives within Medicare for patients receiving treatment in different environments, such as Acute Care Hospitals, Long Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). The demonstration highlighted the necessity for uniform data collection to understand how similar patient populations are managed across these diverse settings and to evaluate the resources and outcomes associated with each.
The CARE Item Set emerged as a direct response to this need for standardization. It is designed to assess a patient’s health and functional status at the point of discharge from an acute care hospital and upon admission and discharge from post-acute care facilities. By utilizing the CARE Item Set, healthcare providers gain a robust tool to measure changes in patient severity and outcomes throughout the post-acute care journey. This standardized approach ensures that critical patient information is consistently captured across different settings, promoting better communication and care coordination.
The scope of the CARE Item Set is comprehensive, encompassing the assessment of patients’ medical, functional, cognitive, and social support status. Its application spans across the continuum of care, including LTCHs, IRFs, SNFs, and HHAs. A primary objective in developing the CARE Item Set was to create a unified set of assessment items that could be integrated into existing assessment tools used in each setting, thereby minimizing the administrative burden on healthcare providers. The tool is built upon extensive prior research and incorporates insights from clinicians working across the spectrum of patient care settings. It targets a range of measures relevant to patient care needs, including factors that influence treatment strategies and staffing considerations, such as indicators of physician, nursing, and therapy intensity.
The CARE Item Set development process was informed by key initiatives and recommendations, notably the 2006 Recommendations for a Uniform Patient Assessment for Post-Acute Care. It aimed to update and harmonize existing federal assessment instruments, including the IRF-Patient Assessment Instrument (IRF-PAI), the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS), alongside other geriatric care measurement efforts. The overarching goal was to create a tool that could effectively measure outcomes in both physical and medical treatments while accounting for variables that can affect these outcomes, such as cognitive impairments and social and environmental determinants. Notably, many of the items included in the CARE Item Set were already being collected in hospitals, SNFs, and HHAs, although variations in item format existed.
The CARE Item Set is structured around two main categories of items: core items and supplemental items. Core items are universally applicable and are administered to every patient within a given setting, irrespective of their specific condition. These items provide a baseline assessment of patient status. Supplemental items, on the other hand, are condition-specific and are only applied to patients presenting with particular conditions. These items are designed to provide a more detailed and nuanced measurement of severity or the extent of need for patients with specific health issues. For instance, while the presence of one or more unhealed pressure ulcers at stage 2 or greater is a core item asked of all patients, supplemental items delve deeper into the characteristics of these ulcers for patients who have them.
The standardization facilitated by the CARE Item Set offers significant advantages. By establishing a common language for clinicians across different care settings, it enhances the ability to accurately measure patient acuity, treatment needs, and outcomes. Furthermore, it streamlines information transfer as patients transition between care environments. This improved communication and data consistency are crucial for effective care planning and for monitoring the quality of care delivered in inpatient rehabilitation and other post-acute care settings.
Building upon the CARE Item Set, the B-CARE, or Brief-CARE, was developed as a more streamlined version. B-CARE is under consideration for use within the Bundled Payments for Care Improvement (BPCI) Initiative. Its purpose is to provide consistent patient information across various BPCI models and care settings. This consistency is vital for monitoring the impact of care redesign initiatives on patient health status and care outcomes. B-CARE data can also be instrumental in understanding how patient mix influences the results observed across different BPCI models and settings.
In conclusion, the CARE Item Set stands as a significant Care Tool In Inpatient Rehabilitation and the broader post-acute care spectrum. Its development and implementation represent a concerted effort to standardize patient assessment, improve data consistency, and enhance the quality and coordination of care. By providing a robust framework for evaluating patient status and outcomes, the CARE Item Set contributes to more effective healthcare delivery and supports ongoing efforts to refine healthcare payment models to better serve patient needs. For further in-depth information, resources such as the Overview of the Medicare Post-Acute Care Payment Reform Initiative, Section 5008. Post-Acute Care Payment Reform Demonstrations Program. Deficit Reduction Act of 2005, and the Post-Acute Care Payment Reform Demonstration: Final Report offer valuable insights into the CARE Item Set and its role in shaping post-acute care.
