The Continuity Assessment Record and Evaluation (CARE) Item Set is a standardized patient assessment tool designed for use in post-acute care settings, including inpatient rehabilitation facilities (IRFs). Developed as part of the Medicare Post-Acute Care Payment Reform Demonstration (PAC-PRD), the CARE Item Set aims to provide a consistent measure of patient health and functional status across various healthcare settings. This allows for better understanding of patient needs, treatment effectiveness, and resource allocation in inpatient rehabilitation care.
Standardizing Inpatient Rehabilitation Assessment with the CARE Item Set
The CARE Item Set was created to address the need for standardized data collection across different post-acute care providers, such as Long Term Care Hospitals (LTCHs), IRFs, Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). This Inpatient Rehabilitation Care Tool facilitates consistent evaluation of a patient’s medical, functional, cognitive, and social support needs.
This standardization allows for:
- Comparison of patient outcomes across different settings: By using a common set of metrics, the CARE Item Set enables researchers and clinicians to compare the effectiveness of different inpatient rehabilitation programs.
- Improved care coordination: Consistent data collection promotes better communication and collaboration between healthcare providers, leading to a more seamless transition for patients between care settings.
- Data-driven payment reform: The CARE Item Set provides valuable data on resource utilization and patient outcomes, informing payment models and incentivizing high-quality care. This was a key objective of the initial Medicare Payment Reform Demonstration (PRD) mandated by the Deficit Reduction Act of 2005.
Components of the CARE Item Set as an Inpatient Rehabilitation Care Tool
The CARE Item Set comprises two key types of items:
- Core Items: These questions are asked of every patient, regardless of their specific condition, providing a baseline assessment of health and functional status. This ensures consistent data collection across all patients within the inpatient rehabilitation setting.
- Supplemental Items: These questions are tailored to patients with specific conditions, allowing for a more detailed assessment of the severity and specific needs related to those conditions. For example, while a core item might ask about the presence of pressure ulcers, a supplemental item would delve into the staging and characteristics of those ulcers. This granular data is crucial for tailoring inpatient rehabilitation care plans.
Development and Refinement of the CARE Item Set for Inpatient Rehabilitation
The CARE Item Set was developed over 14 months, drawing on existing research, clinical expertise, and lessons learned from existing assessment tools like the IRF-Patient Assessment Instrument (IRF-PAI), the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS). This rigorous development process ensured the reliability and validity of the tool in measuring patient outcomes and care needs within inpatient rehabilitation settings. The focus was on items related to patient severity, payment, or quality of care monitoring, excluding items solely used for care planning.
B-CARE: A Streamlined Inpatient Rehabilitation Care Tool
B-CARE, a simplified version of the CARE Item Set, is being explored for use in the Bundled Payments for Care Improvement (BPCI) Initiative. B-CARE aims to provide consistent data across different BPCI models and care settings, furthering the goal of improving care coordination and efficiency in inpatient rehabilitation and other settings.
Conclusion: The CARE Item Set’s Impact on Inpatient Rehabilitation Care
The CARE Item Set provides a valuable framework for standardizing patient assessment in post-acute care, particularly within inpatient rehabilitation facilities. By offering a consistent and comprehensive approach to data collection, the CARE Item Set enables better understanding of patient needs, facilitates care coordination, and informs payment reform efforts. This ultimately contributes to improved quality and efficiency of care for patients undergoing inpatient rehabilitation.
