HRST RATING SYSTEM
Introduction
The HRST was developed to screen for health risks associated with a wide variety of disabilities which specifically affect systems of the body and the person's ability to engage in functional activities. The instrument was designed for the specific needs of detecting health destabilization in a vulnerable population and preventing preventable deaths.
There are several components to the HRST but the heart of the tool is the Ratings Section. Below is an overview of the HRST rating system, which was developed and refined over a period of two decades.
Health Care Levels
The HRST assigns point scores to rating items. The resulting numerical totals are assigned HEALTH CARE LEVELS associated with DEGREES OF HEALTH RISK. For instance:
HEALTH CARE LEVELS
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The most important outcome of the HRST screening is to guide the provision of health care support and surveillance. In these days of managed health care, we wish to avoid using precious and expensive health care resources to oversee healthy individuals who are likely to resent the intrusion anyway. It is important to understand the difference between a disability and health risk. Many people with physical conditions enjoy relatively good health. The majority of individuals in various settings experience health patterns equivalent to the population at large. As the extent of a given disability increases, the chances of health threatening conditions increase.
We know from data gathered from various states that in a large group of persons with developmental disabilities, the following distributions could be expected:
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Low Risk, levels 1 and 2:
About 67-70% of the population, including some individuals who are wheelchair dependent, will have low risk and
require only annual or episodic health care.
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Moderate Risk, levels 3 and 4:
About 21-23% will have moderate health risks, and persons at Level 4 are particularly vulnerable to the onset of insidious,
life threatening problems.
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High Risk, levels 5 and 6:
About 5-7% will fall into the high risk group, and many of these individuals are ambulatory and have behavioral issues which
are difficult to detect without a screening process.
It is these higher groups that need the most frequent surveillance to prevent preventable deaths.
HRST Categories
The HRST is divided into five RATING CATEGORIES, which are useful in quantifying the degree of health risk.
HRST CATEGORIES
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Functional Status has to do with things such as eating, moving about, using the toilet and ability to participate in regular life. We know that the needs for extensive supports in eating and moving are reliable predictors of an early death. When we see loss of skills in any of these areas, we know that something is going on with the individual that needs to be managed.
Behaviors are another area that is indicative of high health risk, and this is often a "which came first, the chicken or the egg" issue. Persons may abuse themselves because they have no other way of telling people they are in pain, or they may abuse themselves for other reasons and the outcome may cause damage to their bodies, such as those individuals who eat inedible objects and harm themselves.
Physiological rates the actual conditions, such as seizures disorders, problems with the GI tract, or other body systems that are crucial to life and limb.
Safety looks at the person's tendency to injuries and falls, which are often a reflection of other body conditions or their housemates' aggression on them.
Frequency of Services looks at the person's requirements for professional health care intervention, emergency room visits and hospitalizations.
Rating Items
Each of the five categories mentioned above is further divided into a total of 22 RATING ITEMS. For example, "Eating" is the first rating item in the "Functional Status" category.
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CATEGORY I - FUNCTIONAL STATUS Rating Item A: Eating
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(Note: "Eating" is only one rating item. There are an additional 21 rating items on the tool not shown here.)
There are a series of yes/no questions for each Rating Item that ensure the correct score is selected by the rater and to ensure scores are consistent amongst different raters.
Each item is sub-divided into a set of descriptors representing a continuum from relatively normal function to conditions that indicate significant health risk. Each point on this continuum is assigned a numerical score. The least involvement is given a numerical assignment of 0. The most involvement is assigned a score of 4. As points accumulate the Health Care Level will rise.
Rating Outcome
The individual ratings and overall score derived from the Health Risk Screening Tool guide the independent support coordinator and health care manager in the provision of appropriate levels and types of health care support and surveillance. Overall scores are used to assign a HEALTH CARE LEVEL, which is associated with a specific DEGREE OF HEALTH RISK.
The Ratings of the twenty-two individual Items are used to determine the need for further assessment and evaluation required by the person in order to be safe and healthy in the least restrictive environment. They are also used to identify service and staff training requirements to address potential and actual health risks.