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Detect Health Risk in At Risk Populations with the Health Risk Screening Tool

The most widely used, validated health risk screening tool for people with disabilities.
HRST-Laptop-Mockup-2

The Health Risk Screening Tool (HRST) offers one of the leading screening tools for intellectual disability risk management and support. This health risk assessment tool is a web-based rating instrument developed to detect health destabilization in at risk populations and ensure that proper care and support is provided at all times. The HRST monitors for health risks associated with developmental and physical disabilities which specifically affect systems of the body and the person’s ability to engage in functional activities. This allows clinicians to make the real-time care decisions that other health screening tools might not support.

Determine the Risk

The most important outcome of the HRST screening is to guide in the provision of health care support and surveillance. The instrument is used to determine the types of further assessment and evaluation required by the person to be safe and healthy in the least restrictive setting.

How it Works

The Health Risk Screening Tool (HRST) is a web-based, HIPAA compliant rating instrument developed to detect health destabilization in at risk populations.

This unique disability screening tool looks for health risks associated with a wide variety of disabilities, including developmental disabilities, physical disabilities, disabilities associated with aging and other conditions, all of which specifically affect systems of the body and the person’s ability to engage in functional activities and which many other health screening tools overlook.

Part of the instrument examines the health risks associated with psychiatric or behavioral disorders, particularly those that result from medications, self-injurious behavior or restriction of movement.

The HRST is a simple 22-item scale designed to find out who is at the greatest risk of illness and health destabilization. It then responds by producing action steps that empower support staff in the form of special attention and prevention.

Scores for 22 rating items are assigned by the user answering a series of objective Yes/No questions related to each item. The resulting numerical totals of the 22 rating items are assigned Health Care Levels associated with degrees of health risk.

Features & Functions:
  • Detects health destabilization early in at risk populations.
  • Field-tested, validated, reliable and user-friendly.
  • Helps meet CMS health and safety requirements.
  • Quantifies level of health risk based on objective criteria.
  • Establishes a health baseline and allows the health status to be monitored.
  • Assists with transition planning and continuity of care.
  • Defines acuity.
  • Identifies health related support needs specific to the person.
  • Determines types of further assessment, evaluation and staff training.
  • Enhances Individual Service Plan development.
  • Enables personalized and less restrictive settings.
  • Assists with budgeting and equitable resource allocation.
  • Provides web-based, real-time data accessibility.
  • Reports can display numerous parameters:
    • State-wide
    • Region
    • County
    • Provider
    • Facility
    • Demographics
    • And more

Validity

Three independent studies have been completed using the Health Risk Screening Tool and were conducted on people with intellectual and developmental disabilities
Journal of Nursing Measurement
“An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities” Vol. 28, Issue 1 –  April 2020

The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.

 

Independent researchers with the Center for Outcome Analysis and the Georgia Department of Behavioral Health and Developmental Disabilities collaborated to study the ability of the HRST to predict mortality in people with IDD. The study highlights the efficacy of the HRST to predict mortality in a sample of 12,582 people with IDD. The researchers concluded that the “HRST’s Health Care Levels are predictive of mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity for people with IDD.” 

A quote from the study

“All three methods of analysis employed in our study (Kaplan–Meier, Cox regression, and binary logistic regression) indicate that the six-point health risk score (i.e., Healthcare Level) produced by the HRST was prognostic of mortality in a sample of persons with intellectual disability. That is, the instrument is able to identify the degree of vulnerability in such a population.

Conclusion

Merrick and Morad (2011)(2) recommend that an HRA (Health Risk Assessment) become a standard component of the life plan of a person with an intellectual disability because it would allow for the detection of conditions that could compromise longevity, and our results suggest that the HRST can meet this need.”

Click here to read the Research Article >

Additional Studies Validating the HRST

The Center for Outcome Analysis (COA)

Predictive Validity of a Health Risk Screening Tool Designed for People with Developmental Disabilities, Michael J. Roszkowski, Ph.D., and James W. Conroy, Ph.D. Center for Outcome Analysis, 2016.
The study was conducted by Dr. James Conroy of the Center for Outcome Analysis and was done on a sample of over 16,000 people with IDD over a nine-year span and concluded that the HRST’s Health Care Level was prognostic of longevity.

 

Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)

A second study is presented by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD). The Annual Mortality Report focuses on mortality, mortality trends, and related information pertaining to the health and care received by individuals with intellectual and developmental disabilities served by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD). The report focuses on an analysis of mortality data and findings from DBHDD’s mortality review process. Reports have been scheduled for publication in August of each year since 2013 and cover the prior calendar year of January 1 through December 31.

The graph below depicts that with each one point increase in Health Care Level, there is a statistically significant increase in the rate of death.

Frequently asked questions

An HRST Rater is a person who completes a screening using the HRST.  The ideal choice for a Rater is a support person who knows the person well, supports them in various environments, or has access to documents and other support people in the person’s life.  The Rater does not have to be a clinician or have a clinical background.  The HRST was designed to be used by those supporters who may not have clinical training. Although some clients opt for nurses to be the Rater, direct support staff or provider managers make for ideal Raters.  Your designated Service Team will assist in choosing the right Raters.
The nurse’s role is vital, even if the nurse is not the designated Rater.  Nurses are trained to complete a process called Clinical Review.  This review can be completed by either an RN or LPN. A Clinical Review is required for all Health Care Levels 3 or higher. The Clinical Review is primarily a quality assurance measure.  Nurses are given additional training to complete this review.  Additionally, nurses can use the screening results to help other non-clinical staff better appreciate identified risks.  Nurses also use the HRST to help them determine who really needs nursing support and to what degree. If the client does not have access to a nurse, the client can opt to use IntellectAbility’s Clinical Review services.
Screening time depends mainly on the medical complexity of the person.  The average screening time of the 22 rating items takes about 30-60 minutes. Updates usually only take a few minutes. Our prerequisite training and ongoing support from our service area will help Raters screen more accurately and efficiently over time.
The HRST should be updated at a minimum once per year.  Think of it as an annual check-up. An ideal time to complete an annual update of the HRST is when preparing to renew the person’s annual plan. However, it is vital that the HRST be updated anytime the person experiences events that would affect scores, such as falls, injuries, seizure activity, ER visits, etc. The goal of the HRST is to track health risk movement so the team can respond appropriately. This can only happen if the Rater keeps the HRST updated.  The importance of this cannot be overstated.  The Service Team and the HRST web-based application will assist users in ensuring everyone is receiving timely updates.
While screening is important, it is not the end but rather the beginning.  Screening reveals where there are potential or current health risks and how intense those risks are. However, if nothing is done about those risks, the person will never benefit from the screening.  The HRST is subject to the same outcome of any tool out there, in that scores can be determined and then just forgotten.  In the case of the HRST, this could mean life or death.  Once a screening is completed, the HRST produces an overall Health Care Level (HCL), which shows overall risk intensity.  Equally important are the HRST Service and Training Considerations.  These Considerations are a product of the screening and give the team direction on how to take action on identified risks. The HRST Service Team’s primary job is to help users understand the importance of the HCL and the proper application of the Considerations.

Studies have validated that the HRST Health Care Levels are predictive of mortality. In fact, a recent study out of the state of Georgia reveals that “similar to previous years, there was a statistical association between HCL and mortality rate in 2018.”  In addition, “each one-unit increase in HCL was associated with an 59% increase in the odds of dying.1”  Knowing each person’s HCL can empower action to prevent unnecessary deaths.  Emphasis on HCL’s will be a major component of our service delivery to the client.

1   2018 Annual Mortality Report, Georgia Department of Behavioral Health and Developmental Disabilities, August 2019.

Every HRST rollout is unique because every client is unique.  HRST rollouts are both flexible and structured.  They are flexible in the sense that they adapt to unique client dynamics but structured to include vetted steps and components that have proven to be successful time and time again.  By gaining information from the client, we can provide a rollout plan that keeps the client’s entire system in mind.  The service department strives to make the rollout of the HRST as easy as possible for the client on all levels.  To this end, we provide protocols, orientation webinars, and materials to ensure those who will use the HRST are prepared and ready.
Every client has a designated HRST Service Team.  This team consists of an Admin Service Rep and a Clinical Service Rep.  The job of this service team is to work with the client not only to ensure a smooth rollout but to help the client get the most out of the HRST beyond the rollout.  This team will work with the client to identify goals the client wishes to meet as a result of using the HRST. The team also provides support to all levels of the client’s system to promote maximum use of the tool.  This includes, at a minimum, state personnel, regional personnel, providers, support staff, case managers, and others. The team remains in close communication with the client and key stakeholders throughout the use of the HRST.
Yes. We offer both technical support and clinical support.  Any user can easily and quickly access our support team to get assistance.
THRST Raters must complete online training before conducting screenings.  HRST online trainings are specifically designed for various support components such as Raters, Clinical Reviewers, case managers, direct support staff, state personnel, etc.
Yes. We have linked with many data systems to import and export data to and from the HRST. Our IT team can work with your current EHR or MAR to provide interoperability between systems. As always, we take HIPAA laws and regulations very seriously, and any transfer of data into or out of the HRST follows best practices related to those laws and regulations.
Most definitely. IntellectAbility opts to have a 3rd party HIPAA compliance audit performed bi-yearly. All employees and contractors must complete HIPAA training at hiring and throughout their involvement with IntellectAbility.

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