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interRAI Newsletter                    
Issue 10 - May 2012

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From the President

   

As interRAI continues to develop as an international collaborative, we have increasingly recognized the need to communicatBrant Friese better with our colleagues around the world-clinicians, caregivers, government regulators, and academics. We envision this Newsletter as a way to tell you more about what is happening within and around interRAI: new products, scientific findings, publications, early developments, and ideas. With activities spanning the globe, intelligence gleaned in one setting becomes increasingly relevant in others.

 

From its beginnings in long-term care, interRAI systems have developed in depth (more functions and greater scientific underpinnings) and breadth (from aged care to disability and mental health services). For example, in this newsletter we report on the adoption of the interRAI system for persons with intellectual disability in a massive program in New York State and the use of interRAI data to set national health policy in Finland.

 

Our erstwhile editor, Professor Len Gray, describes how to continue to subscribe to this publication. We hope you will find our Newsletter issues of interest and will recommend that others join our mailing list.

 

Best wishes to all.

 

Brant Fries
President, interRAI

 

From the Editor

 

Colleagues, thank you for reading our first interRAI newsletter. We hope to bring you news that will enhance your interest in interRAI. This newsletter responds to requests for clearer information about interRAI's many activities, including events, new developments, implementation and adoptions, publications, and launches of instruments and their various components.

 

interRAI is an extensive organization with formal membership of more than fifty "Fellows" from thirty nations. Many others contribute to meetings and research activities. Together, this collaboration produces what we believe to be the world's best assessment systems for aged care, mental health, and disability services. We aim to make systems relevant both to clinicians and service providers at the frontline, and to health service planners, policy makers, and researchers. This is a delicate balance that requires continual adjustment.

 

A wide range of systems and enhancements is currently in development. We have prepared a working list of these activities for your examination. When "release" dates are available, we will publish them. It is important to note that a "release" constitutes the availability of materials for software development - just the first (but critical) step in the realization of an effective assessment and care-planning system.

 

If you have colleagues whom you believe will be interested in receiving this newsletter, please click the "Forward email" link found at the bottom of this message. They will then receive a copy of this email and can click on the "Join Our Mailing List" button to sign up. If you do not wish to receive further editions, simply unsubscribe as indicated below.   

 

Len Gray

Editor

 

 

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News  

 

New York State officially adopts the interRAI Integrated Assessment Suite as the statewide assessment vehicle

 

The State Office for People With Developmental Disabilities (OPWDD) has selected the interRAI Integrated Assessment Suite to serve as the core of the needs assessment process with the People First Waiver system reforms.

 

Use of the interRAI Intellectual Disability (ID) assessment will link OPWDD's service system with the New York State Department of Health (DOH) and a unified data warehouse that supports establishment of "No Wrong Door" access to services. The DOH is currently in the beta testing phase of its Uniform Assessment System with the interRAI Community Health Assessment (CHA) at its core.

 

New York, the third largest state in the USA, is also considering implementation of other interRAI Suite instruments.

 

Click here to read the official announcement by OPWDD.

   

New licenses for the use of the interRAI assessment systems

 

The State of Maryland, USA, recently signed an agreement to implement the interRAI Home Care (HC) statewide. Maryland has 6 million inhabitants.

 

interRAI has renewed its license with the Advanced Healthcare Technology Group to develop software supporting implementation of interRAI assessment systems in China.

 

Implementation of the new interRAI Community Mental Health (CMH) assessment tool has just been executed by a major charitable organization in Hong Kong. Also in Hong Kong, a software vendor recently signed a license agreement to use the interRAI HC and interRAI Long-Term Care Facility (LTCF).

Marseille Conference showcases application of interRAI systems in France

 

A conference hosted by France RAI, Aix-Marseille University, and the University of Versailles, held in Marseille, France, in December 2011 provided a French team with the opportunity to demonstrate its approach and the results of using interRAI instruments.

 

The trial is part of a national program to maintain, as long as possible, the autonomy of patients affected by Alzheimer's disease or other dementia who are living in the community. One action was the choice and use of a comprehensive assessment tool by the leader of the local trial.

 

Two case managers perform assessments to assist in evaluating needs and arranging formal community services. Patients are first seen in different local entry points managed by several Local Authorities agencies. Some professionals within those agencies have begun to use interRAI Contact Assessment (CA) as a routine screener to determine the need for more in-depth assessment.

 

To date, around 250 patients have been assessed and followed for 6 to 18 months. Users were trained in the implementation and interpretation of the interRAI instruments. Training was conducted by the French interRAI fellows, assisted by research nurses. A mechanism to transfer data between sites is currently under development.

 

In the future, the team will extend the use of interRAI instruments to geriatric acute wards and day hospitals, with the goal of moving toward an integrated, multi-setting assessment system.

Research and production grade version of interRAI products

 

interRAI has an elaborate process that supports instrument development. The production process is overseen by the fifteen-member Instrument and Systems Development committee chaired by John Morris. Instruments are "released" in two phases: research and production grade. The ISD committee has 4-day meetings three times a year.

Research grade instruments

 

New instruments that are actively in development are described as "research grade" instruments. Official versions of such instruments are approved by the ISD and are made available to interRAI members and their associates who wish to contribute to the research and development process. Instruments may remain in this state for months or years, depending on opportunities to conduct the necessary field testing and review that brings the system to production grade, including the development of applications such as scales, screeners, quality indicators, and case-mix measures.

 

An example of this process is the Community Cognitive Assessment instrument now in development, led by interRAI fellow Joel Ankri. Shortly, this will be available as a research grade instrument on the website. A manual is being developed but is not yet available. Field testing is anticipated throughout 2012-13.

 

Research grade instruments (and the lead developer) include:

 

*   Subjective Quality of Life for MH, HC, LTCF, AL, independent 

     living and continuing care retirement communities (John      

     Morris)

*   Community Cognitive Assessment instrument (Joel Ankri)

*   Post-Acute Care supplement to the AC (Len Gray)

*   Intellectual Disability (Lynn Martin / Mary James)

 

The translation of research grade instruments to full production is not guaranteed, nor does interRAI generally provide timelines to move to production grade.

Production grade instruments

 

Production grade instruments and other products are those for which testing has been completed and are ready for general distribution. These instruments and their supporting manuals are reviewed in detail by our publishing partner, OBS. In general, but not necessarily, printed versions of these will be available for purchase. Full production to printed versions depends on financial resources. Regardless, these final versions are available on the website for use by licensees and software vendors. (See www.interrai.org)

Developments in Acute Care

 

The second meeting of the interRAI Network of Excellence in Acute Care (iNEAC) was held in Marseille in December 2011. The meeting was lively and productive with topics including:

 

*    Results of analyses of the multinational Emergency Department (ED) study, which recruited 2,300 subjects across seven nations. Over the next few months, papers comparing ED populations and outcome will be concluded. A comprehensive screening strategy starting from the front door of ED using our derived screeners will likely be constructed.

 

*    Evidence that the interRAI AC screeners for delirium and dementia perform at least as well as the Confusion Assessment Method and the Mini-Mental State Examination.

 

*     Presentation of a completed suite of Quality Indicators for Acute Care, expected to be released for general use in late 2012.

 

The iNEAC has an extensive work plan, with a wide range of products, new features, and research projects planned for 2012.

interRAI data used as a road map for Finnish Service Planning

 

The population of Helsinki, the capital of Finland, is rapidly aging. By legislation, the local municipalities are responsible for guaranteeing adequate services for citizens.

 

Fifteen percent of the population of Helsinki was 65 years old or older in 2010, and 6.8% was 75 years or older. In 2020, the corresponding figures will be 19% and 9%.

 

Recognizing these trends, the local municipalities of Helsinki ordered the National Institute for Health and Welfare to investigate the current state of elderly care services and to propose future actions. National statistics including interRAI data together with Helsinki's own statistics and interviews were used. The study was directed by interRAI member Harriet Finne-Soveri.

 

interRAI data indicated greater use of institutional beds and less support for informal care in Helsinki than elsewhere in the country: only 3-8% of those receiving regular home care services expressed that they would prefer to live elsewhere than home, whereas up to 16% of informal caregivers held this opinion. Informal caregiver stress was related to the level of care needs of the older person. The ability of official home care to respond to these needs was only modest.

 

Pressure for increasing institutional care was derived from two major sources: high levels of informal caregiver stress and blockage of acute care hospital beds by persons awaiting transfer to institutional care. The length of stay of hospital patients was far greater than expected and can be attributed to persons awaiting long-term care. The key issue for service planning is considered the organization of additional resources around acute care and rehabilitation to support discharge from hospitals and to minimize the use of emergency services.

 

The analysis also unveiled that the diagnosis of dementia had increased during the past 5 years in those receiving all types of elderly care services. Projections for the prevalence of moderate to severe dementia indicated that there is likely to be considerable and widening variation among areas of the city over the next 10 years. One of society's greatest needs is the ability to increase holistic elderly care planning.

Home Care Reporting System (HCRS) for First Nations and Inuit Health, Alberta, Canada

 

First Nations and Inuit Health, Alberta Region, is proud to announce the successful launch of the Home Care Reporting System (HCRS) in six pilot communities. The FNIH team worked in close collaboration with the communities in planning and implementation of the project, as the project goal was to be "community-based and community-led." The team is continuing to work collaboratively with the communities to ensure that appropriate support and sustainability mechanisms are in place.

National Study of Home Care in Canada Uses interRAI-based Evidence

 

The Health Council of Canada (HCC) recently released a report on the experience of seniors and their caregivers in the Canadian home care system. The HCC report made extensive use of data from interRAI's home care and contact assessment systems to provide a national picture of the needs of home care clients and the services they receive from the formal system. Five of the eight Canadian provinces using the RAI-Home Care were sufficiently far along with their implementation to provide representative data to the Canadian Institute for Health Information (CIHI).

 

The report demonstrated the importance of informal caregivers to the home care system. About three quarters of the care received by Canadian home care clients comes from their family members (usually spouses and children). Some family members work the equivalent of a full time job in providing supports to older persons with high needs according to interRAI's Method for Assigning Priority Levels (MAPLe) system (http://www.biomedcentral.com/1741-7015/6/9). However, this commitment comes at a cost - about one third of caregivers supporting clients with moderate to very high needs are distressed. The HCC report called on governments to ensure that adequate resources are allocated to home in order to provide more support to clients at the highest levels of need. For the system to function well, evidence from the interRAI assessment systems should be used to allocate the right care, to the right person at the right time.

 

To read more about the report, visit the blog posted by interRAI Fellow John P. Hirdes, PhD.

Subscription-Based Access Coming Soon!

 

interRAI is supplementing its paper and electronic book offerings (available at http://catalog.interRAI.org) with an online subscription site, where individuals as well as institutions may subscribe to and access interRAI content - one book at a time, or a whole bookshelf - for less than the cost of a per-copy purchase, from anywhere on the Internet.

 

Content can be either accessed online or downloaded to a proprietary iOffline reader. Your interRAI publications can also be customized with bookmarks, notes, and highlights.

 

Annual subscription pricing is based on the concurrent user model. For example, with the "Long-Term Care Facilities (LTCF) Assessment Form and User's Manual," which lists for $49.45 per ebook, the annual subscription fee for up to five concurrent users is $82, up to ten concurrent users, $161, and so on, incrementally, up to seventy-five concurrent users for an annual fee of $1,051. An institution might license access to the entire interRAI standard suite for five concurrent users for $944 per year, for example.

 

interRAI hopes that the addition of this new functionality will help increase the reach of interRAI instruments worldwide. We look forward to hearing from interested subscribers. As soon as the new site is available, information will be posted at http://catalog.interRAI.org. In the meantime, please contact us by email, or call customer service at +1-866-595-5055 to discuss your institutional needs so we can arrive at a subscription solution that works for you.

 

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Canada RAI conference. Vancouver. May 7-10.  

(www.canadianinterrai.org)  

 

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PublicationsRecent Publications

 

Elliott TR, Phillips CD, Patnaik A, Naiser E, Booth EA, Fournier CJ, Miller TR, Moudouni DM, Hawes C, Dyer JA. Medicaid Personal Care Services and caregivers' reports of children's health: the dynamics of a relationship. Health Serv Res 2011;46(6pt1):1803-21.

 

Guthrie DM, Fletcher PC, Berg K, Williams E, Boumans N, Hirdes JP. The role of medications in predicting activity restriction due to a fear of falling. Journal of Aging and Health 2012;24:269-86.

 

Hirdes JP, Freeman S, Smith TF, Stolee P. Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care. Palliat Support Care 2012:1-9.

 

Neufeld E, Perlman CM, Hirdes JP. Predicting inpatient aggression using the InterRAI risk of harm to others Clinical Assessment Protocol : a tool for risk assessment and care planning. Journal of Behavioral Health Services & Research 2012 (published online before print).

 

Onder G, Carpenter I, Finne-Soveri H, et al. Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study. BMC Health Serv Res 2012;12:5.

 

Onder G, Liperoti R, Fialova D, et al. Polypharmacy in nursing homes in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 2012 (published online before print).

 

Patnaik A, Elliott TR, Moudouni DM, Fournier CJ, Naiser E, Miller TR, Dyer JA, Hawes C, Phillips CD. Severity of children's intellectual disabilities and Medicaid personal care services. Rehabil Psychol 2011;56(4):383-90.

 

Phillips CD, Patnaik A, Moudouni DK, Naiser E, Dyer JA, Hawes C, Fournier CJ, Miller TR, Elliott TR. Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items. BMC Health Serv Res 2012;12:19.

 

Tjam EY, Heckman GA, Smith S, et al. Predicting heart failure mortality in frail seniors: comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0. Int J Cardiol 2012;155:75-80.

 

Wellens NI, Milisen K, Flamaing J, Moons P. Methods to assess the validity of the interRAI Acute Care: a framework to guide clinimetric testing. J Eval Clin Pract 2012;18:296-306.

 

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