What is the PraPlusTM?
How is the PraPlusTM administered?
Who receives the PraPlusTM and how often?
How are the responses to the PraPlusTM used?
How are the risk categories established?
How are the non-scored PraPlusTM questions utilized?
What are the merits of administration by mail verses telephone?
How frequently should the PraPlusTM be administered?
Whom do I contact for more information?
The PraPlus™ is a 17-item screening questionnaire that is used primarily to screen elderly persons to identify those at high risk for heavy use of health-related resources in the future. Its score (Pra™ value) is used to classify persons into risk categories. The Pra™ is the 8-item questionnaire that is contained within the PraPlus™, and is the group of questions to which the scoring algorithm is applied. This is why the score is referred to as the Pra™ value. Once individuals are classified into risk categories, health care organizations can then provide special interventions for the high-risk individuals in an effort to prevent or reduce crises that lead to hospitalization or institutionalization. The Pra™ score has been shown to be a valid predictor of utilization in diverse populations, and has been widely adopted by health care organizations as a central feature of their care delivery systems.
The PraPlus™ is administered to persons over the age of 65. Their responses are used for two purposes:
1. To calculate a Pra™ score that places them into a risk category, and
2. To provide initial additional information needed to plan the appropriate health care of high-risk screenees.
Pra™ stands for Probability of Repeated Admission. As the Pra™ is contained within the PraPlus™, JHTT licenses the PraPlus™ as the final end product. Once a license agreement is fully-executed, JHTT provides licensees with instructions on generating the Pra™ value.
The PraPlus™ can be administered by mail or telephone.
- By Mail. If the PraPlus™ is sent by mail, it must be accompanied by a carefully worded cover letter in order to obtain a high response rate. The cover letter should be brief, friendly, and written at an educational level appropriate for the population. It should emphasize that the person’s responses will help his or her doctor to provide better health care, but that they will not affect eligibility for health insurance. It should mention that another person who is familiar with the person’s health and functional status may help complete the questionnaire. A telephone number should be provided for persons who have questions about how to complete it. If possible, the cover letter should be personalized and signed by the person’s physician. A stamped, addressed return envelope should be enclosed.
To achieve the highest possible response rate, a mailing algorithm should be established. Two to three weeks after the initial mailing, a reminder postcard or a second questionnaire and cover letter should be sent to persons who have not returned the first questionnaire. If still no response three weeks after the second mailing, the PraPlus™ may be administered by telephone or sent again by registered mail (to ensure that the person has received it).
The PraPlus™ questions may be embedded into a longer questionnaire if the health care organization wishes to obtain additional information, but the wording of the eight Pra™ questions should not be altered. It should be remembered that response rates are lower with longer questionnaires. Non-English versions of the PraPlus™ are now being developed but their predictive validity has not yet been tested.
- By Telephone. Alternatively incorporate the PraPlus™ may be administered initially by telephone.
Some health care organizations incorporate the PraPlus™ into welcome call to new members. When administered by telephone, the PraPlus™ requires about seven minutes to complete, including the greeting and introductory statements.
The importance of proper interviewing technique in administering the PraPlus™ by telephone cannot be overemphasized. Well-trained interviewers are essential to obtaining reliable answers and, thus, accurate risk ratings. Interviewers should be selected carefully based on their verbal abilities and interpersonal style. Training sessions for the interviewers should include orientation to the screening program, familiarity with this manual, lectures, supervised practice sessions with feedback, and certification interviews. Training sessions should address topics such as: beginning the interview; pacing; confidentiality; responding to questions; skip patterns; recording data; dealing with reluctant respondents; refusals; and editing. The interviewers must learn to read all the questions exactly as written (to avoid leading the person toward particular responses) and to withhold unscripted comments. “Leading” the person toward on answer or another could potentially decrease the predictive accuracy of the Pra™ value obtained.
Initially, all persons over the age of 65 should receive the PraPlus™. Although the optimal screening frequency is not yet known, it is recommended that the PraPlus™ be administered annually. This allows healthcare organizations to detect persons whose risk status has changed.
The responses to the PraPlus™ questions serve two purposes: calculating Pra™ risk score, and providing additional information about persons who are at high risk.
Persons are placed into risk categories according to their Pra™ risk scores. To do this, thresholds are established that divide the scores into risk categories, either high-and low-risk or high-, moderate-, and low-risk. The thresholds between risk categories can be established using either of two methods:
1. Risk-driven, i.e., using predetermined thresholds, or
2. Resource-driven, i.e., using thresholds that are determined by the number of persons that the organization is prepared to treat high or moderate risk.
Questions 7-15 on the PraPlus™ are designed to provide information that a health care organization may wish to use in planning health-related interventions for its moderate- and high-risk clients. These questions are design to provide a “bridge” to the process of more comprehensive assessment of those at risk. They inquire about functional status, sensory impairment, nutrition, depression, living situation and major medical diagnoses. This part of the PraPlus™ also includes questions that may result in a person who is enrolled in a Medicare risk plan being classified into the “Medicaid” or institutional” rate cells, leading to higher Medicare capitation rates.
It should be noted that these questions are not used to calculate Pra™ risk score and thus are optional. An organization may omit or change them or add additional questions if it desires.
Administration by telephone call produces higher response rates. Written responses may be more accurate.
The PraPlus™ should be administered annually.