Date Presented 04/05/19
This study was conducted to compare the BIMS to alternate screening measures in the identification of individuals with functional cognition and IADL impairment that may compromise community independence post-hospital-discharge. Findings demonstrate that the BIMS, along with a brief performance-based screening measure and self-report, could better identify individuals who are at risk for poor outcomes in acute or postacute settings.
Primary Author and Speaker: Timothy Marks
Additional Authors and Speakers: Brittany Nguyen, Courtney Smith, Erika Hoffman, Hayley Engel, Muhammad Al-Heizan, Gordon Giles, Dorothy Farrar Edwards
PURPOSE: The Centers for Medicare and Medicaid Services (CMS) and the Improving Medicare Post-Acute Care Transformation (IMPACT Act) requires increased screening and support for individuals at risk for hospital readmission after discharge (“Readmissions Reduction Program (HRRP),” 2016). The Brief Interview of Mental Status (BIMS) was introduced to the Minimum Data Set (MDS) 3.0 as a cognitive assessment (Saliba et al., 2012). The BIMS is used in skilled nursing facilities across the USA to establish the presence or absence of cognitive impairment. Increasing evidence suggests that performance-based measures of functional cognition may more accurately assess functional ability and risk of re-hospitalization than neurocognitive measures (Wesson et al, 2016). The purpose of this study was to determine the adequacy of the BIMS to predict cognitive and IADL risk.
DESIGN: The study utilized a cross-sectional observational design to assess a convenience sample of 144 community residing adults. This population was selected as individuals living in the community are the most likely to be discharged back to community living following an acute or post-acute hospitalization (Gaugler et al, 2007). Inclusion criteria for participants included: age 55 years and older, living independently in the community, and able to read and communicate in English.
METHOD: Participants were administered the BIMS, the self-report Alzheimer’s Disease Cooperative Study ADL/IADL scale, the Mini-Cog (a brief cognitive screening tool that includes clock-drawing), and three brief performance-based screening measures of functional cognition known to predict ADL/IADL impairment: a revised version of the Medication Transfer Screen (MTS), the Medi-Cog (a combination of the Mini-Cog and the revised MTS), and the Performance Assessment of Self-Care Skills Medication Task (PMMT). Published criterion scores were used to establish impaired and unimpaired groups for each measure. Using the BIMS and the ADCS as index measures we used ROC analyses to calculate sensitivity, specificity, true positives, true negatives, false positives, and false negatives for each.
RESULTS: Fewer participants were identified as impaired on the BIMS than on other measures of functional cognition: the ADCS identified 9% more individuals as impaired than did the BIMS. The Mini-Cog, MTS, Medi-Cog, and PMMT identified between 12.5% - 37.5% more individuals as impaired than the BIMS. In comparison to the comparison screening measures, sensitivity of the BIMS to cognitive or ADL/IADL impairment was low (≤10%), although specificities were high (93.4% - 96.0%).
CONCLUSION: The addition of a brief performance-based screening measure to assessment with the BIMS and self-report may more effectively identify individuals at risk for poor outcome after discharge from acute or post-acute settings due to impaired functional cognition or impaired ADL/IADL.
IMPACT STATEMENT: Although the BIMS is useful for detecting more severe cognitive impairments, a performance-based measure of functional cognition may be more appropriate in identifying patients at risk for IADL deficits following acute or post-acute hospital discharge, with the potential to reduce hospital recidivism.
References
Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatrics. 2007;7.
Readmissions Reduction Program (HRRP). (2016, April 18). Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
Saliba D, Buchanan J, Edelen MO, et al. MDS 3.0: Brief Interview for Mental Status. Journal of the American Medical Directors Association. 2012;13: 611 - 617.
Wesson, J., Clemson, L., Brodaty, H., & Reppermund, S. (2016). Estimating functional cognition in older adults using observation assessments of task performance in complex everyday activities: A systematic review and evaluation of measurement properties. Neuroscience and Behavioral Reviews,68, 335-360.
