Assuring health and welfare: predictive, proactive, preventative
The Health Risk Screening Tool (HRST) is a web-based rating instrument developed to detect health destabilization in vulnerable populations. The HRST screens for health risks associated with a wide variety of disabilities, including developmental disabilities, physical disabilities, disabilities associated with aging and other conditions, which specifically affect systems of the body and the person’s ability to engage in functional activities. 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 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.
The HRST was developed for use by non-licensed staff such as case managers, independent support coordinators, program staff, direct care professionals and others who directly impact services and supports for individuals in specialized health care settings.
Features / Functions:
- Detects health destabilization EARLY in vulnerable populations
- 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 of individuals to be monitored over time
- Assists with transition planning and continuity of care
- Defines acuity
- Identifies health related support needs of an individual
- Determines what types of further assessment, evaluation and staff training might be required
- 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
- Produces aggregate reports that can be filtered to display data on numerous parameters: state-wide, region, county, provider, facility, demographics, etc.
- Field-tested, reliable and user-friendly
Outcomes and Uses
There are several potential outcomes and uses for the HRST results. The instrument assigns point scores to twenty-two (22) distinct rating items related to functional status, behavior, physiological condition and safety of the individual being screened. Scores for twenty-two 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 twenty-two rating items are assigned Health Care Levels associated with degrees of health risk.
Each individual screened is assigned a Health Care Level, ranging from 1 to 6. The initial ratings for a group or individual serve the purposes of developing a health baseline and determining the range of clinical supports, services and surveillance needs.
Health Care Levels
- Level 1 (LOW RISK): 0 – 12 Points
- Level 2 (LOW RISK): 13 – 25 Points
- Level 3 (MODERATE RISK): 26 – 38 Points
- Level 4 (HIGH MODERATE RISK): 39 – 53 Points
- Level 5 (HIGH RISK): 54 – 68 Points
- Level 6 (HIGHEST RISK): 69 or greater
Once a screening is completed the HRST generates a report containing Service Considerations and Training Considerations in addition to a Scoring Summary of the ratings. This report supplies the provider/support team with guidance in determining the person’s need for further assessment and evaluation to address identified health risks as well as guidance in determining general and individual-specific staff training.
The Service and Training Considerations are where the HRST intersects with the person’s life. It is the implementation of these considerations by the team that assist to prevent preventable health crises and morbidity such as bowel impactions, GI bleeds, aspiration pneumonia, fractures, skin breakdown, etc.
Ratings are done at least annually to assure that the individual’s health is stable. These annual ratings allow managers to check on the health stability of populations. Scores can be tracked by region, provider, case manager or individual residential setting.
The HRST is reviewed and redone when an individual’s status changes, such as emergency room visits, hospitalizations, frequent changes in medications, the use of particular medications and new medical diagnoses.
By utilizing this screening tool, the rating portion allows Nurses to have heightened awareness of present and potential medical concerns so they can be proactive to prevent any further issues/complications.
The HRST not only identifies risk factors, but it also makes recommendations for medical/ medical specialty/ therapy evaluations and staff education related to the individual’s needs. This allows for a proactive approach to healthcare delivery, thus minimizing the health risks to the individual. It is imperative to complete the tool with any change in status with timely implementation of recommendations in order to reap the benefits of the recommendations for care. The HRST was instrumental in the reduction of bowel management problems with a 95% decrease in the number of suppositories used in one developmental center over the course of an approximate 2- year period. This decrease was sustained for a 5+year period.
The HRST has helped immensely in monitoring for unhealthy patterns that might have resulted in detrimental medical outcomes. People are alive today because of the HRST. We observe and assess our individuals very closely as to make certain that they are in the best health possible. The HRST provides us with a snapshot of each individual’s ongoing health status as part of a continual assessment enabling us to observe any adverse health patterns. This allows our team of caregivers to provide better continuity of care with the individual’s health care professionals.