Method for Assigning Priory Levels MAPLe: A New Decision Support System for Home Care

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Method for Assigning Priory Levels (MAPLe) A
New Decision Support System for Home Care

• John P. Hirdes, Ph.D.
• Ontario Home Care Research Knowledge Exchange
  Chair
• Professor, Health Studies Gerontology
• University of Waterloo
• Scientific Director
• Homewood Research Institute

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Method for Assigning Priority Levels (MAPLe)

• Decision support algorithm for RAI-HC developed
  in Ontario
• Growing Canadian and international use
• Used at individual level to prioritize access to
  community and facility based services
• NOT an automatic placement or eligibility tool
• Can also be used in regional and cross-national
  comparisons of practice patterns, outcomes, etc

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Variables used in MAPLe Algorithm

• ADL Hierarchy Scale
• Cognitive Performance Scale
• Behaviour Disturbances
• Wandering
• Verbal abuse
• Physical abuse
• Socially inappropriate
• Resists care
• Worsening of decision-making
• Medication management
• Pressure or stasis ulcers

• Environment
• Bathroom
• Kitchen
• heating/cooling
• Personal safety
• Access to home
• Falls
• Few meals
• Meal preparation
• Swallowing
• Geriatric Screener
• NH Risk CAP

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International Differences in Access to Home
CareDistribution of MAPLe Levels by Country
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Rate of Nursing Home Admissions Within 90 Days of
Assessment by MAPLe Level, Ontario, Derivation
Sample
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Relationship between MAPLe and signs of caregiver
stress in selected Canadian Provinces
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Rate of Caregiver Distress by Percentage of
Clients with MAPLe Level 4 or 5, by Country
IT
DL
ON
FR
UK
DK
NO
NL
CZ
IS
SW
FI
Pearsons r0.84
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility
MAPLe Low Mild Moderate High Very High
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility
MAPLe Low Mild Moderate High Very High
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility
MAPLe Low Mild Moderate High Very High
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility
MAPLe Low Mild Moderate High Very High
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility
MAPLe Low Mild Moderate High Very High
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Using MAPLe for Eligibility Determination
Expected Service Type I R Home Care LTC
Facility

• Case Manager
• Review
• Self-rated health
• Poor stamina
• Prior hospitalizations
• Emergency visits
• Caregiver needs
• Hrs of informal care
• Hrs of formal care
• Family Preferences
• Client Preferences
• CHESS Score
• 24 hr supervision

MAPLe Low Mild Moderate High Very High
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Using MAPLe for Matching Services to Needs
Expected Service Type I R Home Care LTC
Facility
Actual Service Type I R Homemaking Personal
Care Home Care LTC Facility CCC Facility

• Case Manager
• Review
• Self-rated health
• Poor stamina
• Prior hospitalizations
• Emergency visits
• Caregiver needs
• Hrs of informal care
• Hrs of formal care
• Family Preferences
• Client Preferences
• 24 hr supervision

MAPLe Low Mild Moderate High Very High
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Average Weekly Cost of Formal Home Care Services
by MAPLe Level by ON-LHIN, 2005
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Average Weekly Cost of Formal Home Care Services
by MAPLe Level by ON-LHIN and WRHA, 2005
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Provincial Differences in Nursing Home Placement
by MAPLe Level, Ontario WRHA, 2005
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How is MAPLe Useful for Aging at Home Strategy?

• Person-level clinical decision-making
• Scientifically sound tool to inform home care
  professionals
• Benchmarking and accountability
• Comparing rates of LTC placement by LHIN and over
  time
• Canadian and international comparisons
• Evaluation
• Stratified analyses to examine impact of
  innovations

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