Applying the Brief Interview for Mental Status in a Diverse Home Health Patient Population

In 2023, the Brief Interview for Mental Status (BIMS) was added to the Medicare-funded home health (HH) standard patient assessment (Outcomes and Assessment Information Set [OASIS]). This is the first validated cognitive screening tool in the OASIS, but no existing work reports on BIMS implementation in real-world HH clinical practice, overlap between BIMS and clinician-reported cognitive symptoms in the OASIS, or patient characteristics associated with lower BIMS scores.

Cross-sectional study.

We examined 2023 to 2024 OASIS clinical assessments for 42,745 older (65+) patients at a large, urban HH agency.

BIMS scores range from 0 (severe impairment) to 15 (cognitively intact). We describe BIMS score distribution, report overlap between BIMS scores and other OASIS items describing patient cognition, and fit a multivariable model predicting a BIMS score indicating cognitive impairment (score <13).

Based on the BIMS score, 78% of patients were cognitively intact, 15% moderately impaired, and 7% severely impaired. Over half (59%) received the maximum possible score of 15, indicating no impairment. Even among those with probable dementia, reported memory deficits, or reported impaired decision-making, one-quarter scored as cognitively intact (25%, 25%, and 22%, respectively). Patients were more likely to score as cognitively impaired if they primarily spoke Spanish (adjusted odds ratio [aOR], 1.58; 95% CI, 1.42-1.76) or another language (aOR, 1.54; 95% CI, 1.41-1.67) compared with English, were non-Hispanic Black (aOR, 1.44; 95% CI, 1.34-1.54), Hispanic (aOR, 1.38; 95% CI, 1.25-1.53), Asian (aOR, 1.34; 95% CI, 1.20-1.48), or other race/ethnicity (aOR, 1.51; 95% CI, 1.35-1.70) compared with non-Hispanic White, or paid for HH using Medicaid compared with traditional Medicare (aOR, 1.34; 1.24-1.44).

Findings suggest value in combining BIMS scores with other data elements to inform care planning and indicate a need for additional resources and training to ensure BIMS is implemented as intended across subgroups.