Minimum Data Set 3.0 Resident Assessment Instrument User`s Manual
Contents
1. Let s go back to an earlier question What were those three words that I asked you to repeat If the resident is unable to remember a word provide Category cues again but without using the actual word Therefore Category cues for o CO0400A should be written as something to wear o C0400B should be written as a color and C0500C should be written as a piece of furniture 7 If the resident chooses not to answer a particular item accept his or her refusal and move on to the next questions For C0200 through C0400 code refusals as incorrect 8 Rules for stopping the interview are the same as if for administering the BIMS verbally The following resources may be used or the facility may develop their own If the facility develops their own they must use the exact language as in these resources October 2011 Appendix E 9 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Written Introduction Card BIMS Items C0200 C0400 I would like to ask you some questions which I will show you in a moment We ask everyone these same questions This will help us provide you with better care Some of the questions may seem very easy while others may be more difficult We ask these questions so that we can make sure that our care will meet your needs Written Instruction Cards Item C0200 Repetition of Three Words I have written 3 words for you to remember Please read the2. Column 2 that have non missing values multiply the sum by 9 8 1 125 and place the result rounded to the nearest integer in item D0300 e If the number of missing items in Column 2 is equal to two then compute the simple sum of the seven items in Column 2 that have non missing values multiply the sum by 9 7 1 286 and place the result rounded to the nearest integer in item D0300 e Ifthe number of missing items in Column 2 is equal to three or more but at least one of the items in Column 2 is not equal to dash then item D0300 must equal 99 If all of the items in Column 2 are equal to dash then enter dash in item D0300 October 2011 Appendix E 1 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Resident Mood Interview Total Severity Score D0300 cont Example 1 All Items in Column 2 Have Non missing Values The following example shows how to score the resident interview when all of the items in Column 2 have non missing values Item D0200A2 D0200B2 D0200C2 D0200D2 D0200E2 D0200F2 D0200G2 D0200H2 D020012 D0300 Value In this example all of the items in Column 2 have non missing values i e none of the values are skipped or equal to dash Therefore the value of D0300 is equal to the simple sum of the values in Column 2 which is 14 Example 2 One Missing Value in Column 2 The following example shows how to score the resident interview when one of the items in Column 2 has a missing v
3. We ask everyone these same questions This will help us provide you with better care Some of the questions may seem very easy while others may be more difficult We ask these questions of everyone so we can make sure that our care will meet your needs October 2011 Appendix E 8 CMS s RAI Version 3 0 Manual Appendix E PHQ9 6 Directly provide the written questions for each item in C0200 through C0400 at one sitting and in the order provided For each BIMS question show the resident a sheet of paper or card with the instruction for that question from the form clearly written in a large enough font to be easily seen The resident may respond to any of the BIMS questions in writing Show separate sheets or cards for each question or statement For C0200 items instructions should be written as Ihave written 3 words for you to remember Please read them Then I will remove the card and ask you repeat or write down the words as you remember them Category cues should be provided to the resident in writing after the resident s first attempt to answer Written category cues should state sock something to wear blue a color bed a piece of furniture For C0300 items instructions should be written as C0300A Please tell me what year it is right now C0300B What month are we in right now C0300C What day of the week is today For C0400 items instructions should be written as
4. rounded result in D0300 October 2011 Appendix E 3 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Resident Mood Interview Total Severity Score D0300 cont Example 4 Three or More Missing Values in Column 2 The following example shows how to score the resident interview when three or more of the items in Column 2 have missing values and at least one of the values is not equal to dash Item D0200A2 D0200B2 D0200C2 D0200D2 D0200E2 D0200F2 D0200G2 D0200H2 D020012 D0300 Value 0 1 2 2 2 99 In this example three of the items in Column 2 have missing values DO200E2 and DO0200F2 are blank or skipped and DO200H2 is equal to dash The other 6 items have non missing values and at least one of these items is not equal to dash Because three or more items have missing values D0300 is equal to 99 Example 5 All Items in Column 2 Have Dashes The following example shows how to score the resident interview when all of the items in Column 2 have dashes October 2011 Item D0200A2 D0200B2 D0200C2 D0200D2 D0200E2 D0200F2 D0200G2 D0200H2 D020012 D0300 Value Appendix E 4 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Resident Mood Interview Total Severity Score D0300 cont In this example all of the items in Column 2 contain dashes In this special case enter a dash in D0300 enter a single dash in the leftmost space of D0300 and leave the second space b
5. CMS s RAI Version 3 0 Manual Appendix E PHQ9 APPENDIX E PHQ 9 SCORING RULES AND INSTRUCTION FOR BIMS WHEN ADMINISTERED IN WRITING Scoring Rules Resident Mood Interview Total Severity Score D0300 e Item D0300 is used to store the total severity score for the Resident Mood Interview The score in item D0300 is based upon the sum of the values that are contained in the following nine items DO200A2 DO200B2 DO200C2 DO200D2 DO200E2 DO0200F2 DO200G2 DO0200H2 DO20012 These are referred to as the items in Column 2 below e The following rules explain how to compute the score that is placed in item D0300 These rules consider the number of missing items in Column 2 which is the number of items in Column 2 that are either skipped or are equal to dash An item in Column 2 could be skipped if the corresponding item in Column 1 was equal to 9 no response An item in Column 2 could be equal to dash if the item could not be assessed for some other reason e g if the resident was unexpectedly discharged before the assessment could be completed e If all of the items in Column 2 have a value of 0 1 2 or 3 i e they all contain non missing values then item D0300 is equal to the simple sum of those values e If any of the items in Column 2 are skipped or equal to dash then omit their values when computing the sum e If the number of missing items in Column 2 is equal to one then compute the simple sum of the eight items in
6. alue October 2011 Item D0200A2 D0200B2 D0200C2 D0200D2 D0200E2 D0200F2 D0200G2 D0200H2 D020012 0300 Value 0 N N e N WO Re 12 Appendix E 2 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Resident Mood Interview Total Severity Score D0300 cont In this example one of the items in Column 2 D0200E2 has a missing value it is blank or skipped and the other 8 items have non missing values D0300 is computed as follows 1 Compute the sum of the 8 items with non missing values This sum is 11 2 Multiply this sum by 1 125 In the example 11 x 1 125 12 375 3 Round the result to the nearest integer In the example 12 375 rounds to 12 4 Place the rounded result in D0300 Example 3 Two Missing Values in Column 2 The following example shows how to score the resident interview when two of the items in Column 2 have missing values Item Value D0200A2 0 D0200B2 1 D0200C2 2 D0200D2 2 D0200E2 D0200F2 0 D0200G2 1 D0200H2 D020012 2 D0300 10 In this example two of the items in Column 2 have missing values DO200E2 is blank or skipped and DO200H2 is equal to dash The other 7 items have non missing values D0300 is computed as follows 1 Compute the sum of the 7 items with non missing values This sum is 8 2 Multiply this sum by 1 286 In the example 8 x 1 286 10 288 3 Round the result to the nearest integer In the example 10 288 rounds to 10 4 Place the
7. have non missing values multiply the sum by 10 8 1 250 and place the result rounded to the nearest integer in item D0600 e If the number of missing items in Column 2 is equal to three or more then enter a dash in item D0600 October 2011 Appendix E 5 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Staff Assessment of Resident Mood Total Severity Score D0600 cont Example 1 All Items in Column 2 Have Non missing Values The following example shows how to score the resident interview when all of the items in Column 2 have non missing values Item DOS500A2 D0500B2 D0500C2 D0500D2 D0500E2 D0500F2 D0500G2 D0500H2 D050012 D0500J2 D0600 Value In this example all of the items in Column 2 have non missing values i e none of the values are skipped or equal to dash Therefore the value of D0600 is equal to the simple sum of the values in Column 2 which is 15 Example 2 One Missing Value in Column 2 The following example shows how to score the resident interview when one of the items in Column 2 has a missing value October 2011 Item D0500A2 D0500B2 D0500C2 D0500D2 D0500E2 D0500F2 D0500G2 D0500H2 D050012 D0500J2 D0600 Value 0 N Ne at Oron eaa 13 Appendix E 6 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Staff Assessment of Resident Mood Total Severity Score D0600 cont In this example one of the items in Column 2 DO500E2 has a missi
8. lank Scoring Rules Staff Assessment of Resident Mood Total Severity Score D0600 e Item D0600 is used to store the total severity score for the Staff Assessment of Resident Mood The score in item D0600 is based upon the sum of the values that are contained in the following ten items DOSOOA2 DOS500B2 DOSOOC2 DOSO0D2 DOS500E2 DOSO0F2 DOS500G2 DOSOOH2 DOS00I2 DO500J2 These are referred to as the items in Column 2 below e The following rules explain how to compute the score that is placed in item D0600 These rules consider the number of missing items in Column 2 which is the number of items in Column 2 that are equal to dash an item could be equal to dash if the it could not be assessed for example if the resident was unexpectedly discharged before the assessment could be completed e If all of the items in Column 2 have a value of 0 1 2 or 3 i e they all contain non missing values then item D0600 is equal to the simple sum of those values e If any of the items in Column 2 are equal to dash then omit their values when computing the sum e If the number of missing items in Column 2 is equal to one then compute the simple sum of the nine items in Column 2 that have non missing values multiply the sum by 10 9 1 111 and place the result rounded to the nearest integer in item D0600 e Ifthe number of missing items in Column 2 is equal to two then compute the simple sum of the eight items in Column 2 that
9. m Then I will remove the card and ask you repeat or write down the words as you remember them October 2011 Appendix E 10 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Word Card Item C0200 SOCK BLUE BED Category Cue Card Item C0200 SOCK something to wear BLUE a color BED a piece of furniture October 2011 Appendix E 11 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Written Instruction Cards Item C0300 Temporal Orientation Statement Card CO300A Year Please tell me what year it is right now Question Card C0300B Month What month are we in right now October 2011 Appendix E 12 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Question Card Item C0300C Day What day of the week is today Written Instruction Card Item C0400 Recall Let s go back to an earlier question What were those three words that I asked you to repeat October 2011 Appendix E 13 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Category Cue Card Item C0400A Sock Something to wear Category Cue Card Item C0400B Blue A color October 2011 Appendix E 14 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Category Cue Card Item C0400C A piece of furniture October 2011 Appendix E 15
10. ng value it is equal to dash and the other 9 items have non missing values D0600 is computed as follows 1 Compute the sum of the 9 items with non missing values This sum is 12 2 Multiply this sum by 1 111 See bullet 5 on page E 5 for calculation of multiplier In the example the sum of non missing values is 12 Therefore the calculation is 12 x 1 111 13 332 3 Round the result to the nearest integer In the example 13 332 rounds to 13 4 Place the rounded result in D0600 Example 3 Two Missing Values in Column 2 The following example shows how to score the resident interview when two of the items in Column 2 have missing values Item Value DOS500A2 0 D0500B2 1 D0500C2 2 D0500D2 2 D0500E2 D0500F2 0 D0500G2 1 D0500H2 D050012 2 D0500J2 1 D0600 11 In this example two of the items in Column 2 have missing values D0500E2 and DO0500H2 are equal to dash The other 8 items have non missing values D0600 is computed as follows 1 Compute the sum of the 8 items with non missing values This sum is 9 2 Multiply this sum by 1 250 See bullet 6 on page E 5 for calculation of multiplier In the example the sum of non missing values is 9 Therefore the calculation is 9 x 1 250 11 250 3 Round the result to the nearest integer In the example 11 250 rounds to 11 4 Place the rounded result in D0600 April 2012 Appendix E 7 CMS s RAI Version 3 0 Manual Appendix E PHQ9 Scoring Rules Staff Asses
11. sment of Resident Mood Total Severity Score D0600 cont Example 4 Three or More Missing Values in Column 2 The following example shows how to score the resident interview when three or more of the items in Column 2 have missing values Item Value DOS500A2 0 D0500B2 1 D0500C2 2 D0500D2 2 D0500E2 D0500F2 D0500G2 1 D0500H2 D050012 2 D0500J2 D0600 In this example three of the items in Column 2 have missing values DOSOOE2 DOS500F2 and DOSOOH2 are equal to dash Because three or more items have missing values enter a dash in D0600 enter a single dash in the leftmost space of D0600 and leave the second space blank Instructions for BIMS When Administered in Writing When staff identify that the resident s primary method of communication is in written format the BIMS and Category Cues can be administered in writing The administration of the BIMS in writing should be limited only to this circumstance 1 Interview any resident not screened out by Should Brief Interview for Mental Status Be Conducted item C0100 Conduct the interview in a private setting Residents with visual impairment should be tested using their usual visual aids Minimize glare by directing light sources away from the resident s face and from written materials Provide a written introduction before starting the interview Suggested language I would like to ask you some questions which I will show you in a moment
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