Contacts Editor:
Len Gray
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From the Editor
interRAI continues to move forward positively.
In this newsletter, we refer to several major new developments and implementations. Work with paediatric instruments is maturing, in both general and mental health domains.
Specialist groups within interRAI-the interRAI Networks of Excellence in Acute Care (iNEAC) and in Mental Health (iNEMH)-continue to be highly active. They have markedly broadened the engagement of clinicians and researchers in those domains.
The research effort continues to accelerate. The long list of recent publications below reflects our strong commitment to good science. The work on linking genetic profiles to interRAI assessments in Iceland is particularly exciting.
Len Gray
Editor
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News
interRAI Methodology Plays a Key Role in Crucial Genetic Research Relating to Alzheimer's Disease and Cognitive Function
Iceland interRAI Fellow Dr. Palmi Jonsson shares a rather interesting development that demonstrates how the interRAI methodology may play a crucial role in an unexpected way. The journal Nature recently published a study that describes the identification of the first protective genetic variant against Alzheimer's disease. interRAI MDS 2.0 researchers have been collecting data in Icelandic nursing homes for more than a decade and have linked this data to large databases of genetic samples.
The nursing home sample contained people who have demonstrated remarkably stable cognitive function over a long period of time as assessed with the Cognitive Performance Scale (CPS). These people, who have become "super-controls" with whom to compare others with Alzheimer´s disease, demonstrated stable cognitive function through the ages of 80 to 100 years.
This has led to the discovery that these super-controls have a mutation in the APP gene (A673T). Even if this mutation is only found in 1% of the population, the finding demonstrates a principle: This is nature's "preventive treatment" against Alzheimer´s disease. Apart from giving researchers confidence in the path forward for protective drug development by supporting the amyloid hypothesis, this result also provides indirect support for the hypothesis that the pathogenesis of Alzheimer´s disease and normal cognitive decline of the elderly may be shared, at least in part. The paper can be found online here.
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Implementation of interRAI HC for Children Receiving Home Care
interRAI Fellows Catherine Hawes and Charles Phillips are working with the Texas Health and Human Services Commission (HHSC) to develop and test a nursing assessment for children in need of skilled nursing care at home. This instrument focuses on children who may be in need of continuous skilled nursing care. The reliability testing of the instrument will begin in January, 2013 among 30 to 40 home care agencies in Texas. They hope to continue work with HHSC to finalize and implement a more comprehensive assessment such as the HC-Peds for all children receiving any home care in Texas. Hawes and Phillips have also completed their work with staff in the state of New York for the purpose of adding an HC-Peds instrument to the elements of the suite being implemented in that state.
For those interested in nursing homes and the Affordable Care Act (ObamaCare), Dr. Hawes and her colleagues at the Texas A&M Health Science Center recently published an article in a special issue of Aging and Social Policy devoted to the effects of different aspects of the act on the care of older persons. The article can be found here.
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Fitness Regimens, Well Beyond Shuffleboard
The May 9, 2012, the print edition of the New York Times carried a significant article about Hebrew SeniorLife (HSL), which is located in Boston, Massachusetts. In "Fitness Regimens, Well Beyond Shuffleboard," the Times features Orchard Cove, HSL's Institute for Aging Research, and Vitality 360, a research-based approach to wellness and fitness, which use the interRAI CHA and interRAI Wellness as its key assessment instruments. Using the information from these interRAI assessments each resident establishes a life vision (e.g., maintaining close relationships with family) and goals (e.g., exercising to feel strong enough to board a plane alone), and an interdisciplinary team dedicates itself to helping the resident achieve them.
HSL's researchers developed Vitality 360, the leadership and clinicians at Orchard Cove field-tested and improved it, and it is now being rolled out to other HSL communities. According to HSL CEO Len Fishman, "This is precisely what research in an applied setting is all about: scientists collaborating with caregivers, with seniors themselves actively participating in the process."
Executive Director Aline Russotto, Chief Medical Officer Dr. Rob Schreiber, Vitality 360 Coach Susan Flashner Fineman, and resident Natalie Waterman were quoted in the article. You can read the article in full online here.
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Home Care Reporting System (HCRS) for First Nations and Inuit Health, Alberta, Canada
First Nations and Inuit Health (FNIH), Alberta Region, recently announced the successful launch of a Home Care Reporting System (HCRS)-based on the interRAI HC-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 continues to work collaboratively with the communities to ensure that appropriate support and sustainability mechanisms are in place.
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AC Delirium Screener Improves Delirium Diagnosis in Hospital Care
A study recently published in the Journal of Nutrition, Health & Aging demonstrated that the interRAI AC can be used to screen for delirium with similar precision to the industry standard-the Confusion Assessment Method (or CAM). Dr. Salih Salih, working with Professor Len Gray's group at the University of Queensland, developed an algorithm to detect clinician-determined delirium in a large hospital population. The screener has a sensitivity of 82%, specificity of 91%, PPV of 72%, and NPV of 95%. It works equally well in patients with or without impaired premorbid cognitive function. This work adds to the value of the interRAI AC, for which the goal is to produce derivative measures "at least as good as commonly used standalone measures." This algorithm will be included in the specifications for the interRAI AC. See article here.
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2012 interRAI Network of Excellence in Mental Health (iNEMH) Meeting
The interRAI Network of Excellence in Mental Health (iNEMH) had its sixth annual meeting in St. John's, Newfoundland, Canada, in May 2012. The wide-ranging agenda dealt with a broad spectrum of mental health issues affecting persons of all ages. The offerings included the now-completed research on a new assessment system for child and youth mental health services (see article on interRAI ChYMH), and review of the first drafts of CAPs for these instruments took place at the meeting. In addition, researchers presented positive results from a pilot study of the interRAI Brief Mental Health Screener (BMHS) with police services in Ontario, Canada.
Work is also underway to refine the interRAI Mental Health-Correctional Facilities version in response to substantial interest in this system in a number of countries. Other research findings reported at iNEMH include further refinements to Mental Health Quality Indicators, extension of the Cognitive Performance Scale, telemedicine and mental health, pharmaco-epidemiological studies with interRAI MH data, pilot studies of the interRAI Mental Health Quality of Life survey in Russia and Finland, and mental health issues among persons with neurological conditions.
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2012 interRAI Network of Excellence in Acute Care (iNEAC)
The interRAI Network of Excellence in Acute Care (iNEAC) held its third meeting in Waterloo, Canada, in early September. Attended by twenty-three delegates, the meeting was highly productive and engaging. Activities of the group of interest include:
- Development of a standalone pre-screener to identify patients requiring further assessment using the full ED or AC systems
- Completion of AC CAPs and QIs
- Production of a manual for the AC encompassing Problem Lists, Scales, Screeners, Clinical Action Points, Quality Indicators, and Patient Profiles, scheduled for release in early 2013
- International studies to support development of ED QIs.
Four members of iNEAC have been awarded Associate Fellowship status: George Heckman, Marie-Jeanne Kergoat, and Samir Sinha from Canada and Melinda Martin-Khan from Australia.
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Newfoundland and Labrador Adopt the interRAI Mental Health and Community Mental Health Systems
At a one-day conference preceding the 2012 iNEMH meeting, the Hon. Susan Sullivan, Minister of Health and Community Services for Newfoundland and Labrador, Canada, announced that the province will adopt the interRAI Mental Health and Community Mental Health assessment systems as the standard instruments to be used for mental health services in that province. The Canadian Institute for Health Information (CIHI) and interRAI Canada are collaborating with the provincial government to support the early phase of adoption of those instruments. In addition to the MH and CMH, the province has already begun implementation of interRAI assessments for the nursing home and home care sectors.
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New interRAI Child and Youth Mental Health (ChYMH) Assessment System
Shannon Stewart has successfully led a multi-year effort to create the interRAI Child and Youth Mental Health (ChYMH) assessment system in collaboration with iNEMH members and other interRAI colleagues leading work on a paediatric home care system. The interRAI ISD committee has now officially approved the ChYMH for regular use in any jurisdiction that wishes to adopt the instrument. CAPs are under development as are a companion instrument for children and youth with intellectual and developmental disabilities, an adolescent supplement, and a youth justice supplement. The ChYMH represents a major step forward for interRAI's ability to address mental health issues across the life course. This is particularly important given that lifelong issues with mental health often first appear during childhood and adolescence.
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Expertise Centre in Forensic Psychiatry (EFP) Pilot Study in the Netherlands
Since September 2011, interRAI and the Expertise Centre in Forensic Psychiatry (EFP) have been collaborating in pilot studies of the interRAI Mental Health (MH) and Community Mental Health (CMH) in the forensic sector in the Netherlands. The EFP sites will also participate in research to support further development of the Forensic Supplement. This project is part of a Forensic Routine Outcome Monitoring (ROM) project financed by both the Dutch Ministry of Security and Justice and the collaborating forensic clinics. A steering committee of researchers, administrators, and clinicians provides oversight to the EFP pilot, and it recently approved extension of the project to a third phase with large-scale use of the instruments in six forensic mental health settings across the Netherlands (http://www.efp.nl/project/interrai).
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Extensive Examination of interRAI AC Clinimetrics
In June 2012, PhD candidate Nathalie Wellens successfully defended her thesis at the Katholieke Universiteit Leuven in Belgium. In her thesis, "Caring for patient data: Clinimetrics of the interRAI Acute Care as a comprehensive geriatric assessment," she extensively examined the clinimetric values of the interRAI Acute Care instrument in a variety of clinical settings (various ward types) and for a variety of user profiles (e.g., physicians, nurses, allied health professionals, social services professionals).
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Award in Graduate Supervision to John Hirdes
John Hirdes (interRAI Fellow Canada) recently received the University of Waterloo Award for Excellence in Graduate Supervision. The university presented the award at its Spring 2012 Convocation. The award recognizes a faculty member who excels as "a mentor, an advisor, a role model, a humanist and a strategist" and who is "a caring and effective supervisor [who] possesses a high level of energy and ingenuity."
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inSPIRe Program
The inaugural interRAI Summer Program for International Research (inSPIRe) was held at the University of Waterloo in August of this year. The university's Waterloo international division provided matching funding to interRAI to support a one-week training and collaborative research program for doctoral students, postdoctoral fellows, medical residents, and junior faculty members. Twenty-four participants from fifteen countries were involved in the program with eleven interRAI Fellows and members of the interRAI Network of Canada serving as mentors. The program involved instruction by established interRAI researchers on a broad range of applications of interRAI instruments to diverse target populations across the continuum of care. In the afternoon, participants collaborated in small groups to analyse data from home care, nursing home, mental health (inpatient and community), and palliative care settings. Participants then presented the results of this research to an invited audience of decision makers from all health care sectors in Ontario.
The outcomes of the inSPIRe program will include several papers to be published in peer-reviewed journals and a grant proposal developed jointly by the inSPIRe participants. More importantly, the program accelerated the development of new international collaborations among young researchers that represent a promising future for interRAI.
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New members and promotions
Dr. Anja Declercq Promoted to Associate Professor
Dr Anja Declercq was promoted to Associate Professor as of October 1, 2012.
Dr. Declercq has a degree in applied economics and in sociology as well as a PhD in social sciences. She is currently a professor in the Faculty of Social Sciences of the Katholieke Universiteit Leuven in Belgium and project manager at Lucas, an interdisciplinary research institute of that same university. Her research mainly focuses on care for elderly people in terms of innovation and quality improvement.
In Belgium, Dr. Declercq manages a government-sponsored project to research the conditions in which interRAI Long-Term Care Facilities (LTCF) and interRAI Home Care (HC) could be implemented at a national level. She is also involved in a project concerning the use of interRAI Acute Care (AC). She became an Associate interRAI Fellow in 2007.
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Recent Publications
Armstrong JJ, Zhu M, Hirdes JP, Stolee P. (2012). K-means cluster analysis of rehabilitation service users in the Home Health Care System of Ontario: Examining the heterogeneity of a complex geriatric population. Arch Phys Med Rehabil. Jun 14. [Epub ahead of print]
Aschbrenner KA, Cai S, Grabowski DC, Bartels SJ, Mor V. (2011). Medical comorbidity and functional status among adults with major mental illness newly admitted to nursing homes. Psychiatr Serv. 62(9):1098-100. PubMed PMID: 21885592.
Bentkover J, Cai S, Makineni R, Mucha L, Treglia M, Mor V. (2012). Road to the nursing home: Costs and disease progression among Medicare beneficiaries with ADRD. Am J Alzheimer's Dis Other Demen. 27(2):90-9. PubMed PMID: 22495336.
Cai S, Feng Z, Fennell ML, Mor V. (2011). Despite small improvement, black nursing home residents remain less likely than whites to receive flu vaccine. Health Aff (Millwood). 30(10):1939-46. PubMed PMID: 21976338.
Costa AP, Poss JW, Peirce T, Hirdes JP. (2012). Acute care inpatients with long-term delayed discharge: Evidence from a Canadian health region. BMC Health Serv Res. Jun 22;12(1):172.
Dosa D, Hyer K, Thomas K, Swaminathan S, Feng Z, Brown L, Mor V. (2012). To evacuate or shelter in place: Implications of universal hurricane evacuation policies on nursing home residents. J Am Med Dir Assoc. 13(2):190.e1-7. PubMed PMID: 21885350; PubMed Central PMCID: PMC3264770.
Flick U, Garms-Homolová V, Herrmann WJ, Kuck J, Röhnsch G. (2012). "I can't prescribe something just because someone asks for it . . ." Using mixed methods in the framework of triangulation. Journal of Mixed Methods Research. 6:97.
DOI: 10.1177/1558689812437183.
Foebel AD, Hirdes JP, Heckman GA. (2012). Caregiver status affects medication adherence among older home care clients with heart failure. Aging Clin Exp Res. Jun 25. [Epub ahead of print]
Gozalo P, Teno JM, Mitchell SL, Skinner J, Bynum J, Tyler D, Mor V. (2011). End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med. 365(13):1212-21. PubMed PMID: 21991894; PubMed Central PMCID: PMC3236369.
Hawes C, Moudouni D, Edward R, Phillips CD. (2012). Nursing homes and the affordable care act: A cease-fire in the ongoing struggle over quality reform. Aging and Social Policy. 24(2):206-20. DOI: 10.1080/08959420.2012.660046
McMaughan Moudouni DK. & Phillips CD. (2012). In-hospital mortality and unintentional falls among older adults in the United States. Journal of Applied Gerontology. [Epub ahead of print] DOI: 10.1177/0733464812445615
McMaughan Moudouni DK, Ohsfedlt RL, Miller TR, Phillips CD. (2012). The relationship between formal and informal care among adult Medicaid personal care services recipients. Health Services Research. 47(4):1642-1659
Mor V, Intrator O, Unruh MA, Cai S. (2011). Temporal and geographic variation in the validity and internal consistency of the Nursing Home Resident Assessment Minimum Data Set 2.0. BMC Health Serv Res. 11:78. PubMed PMID: 21496257; PubMed Central PMCID: PMC3097253
Phillips CD, Fournier Dyer J, Patnaik A, Hawes C, Miller T, Naiser E, Elliott T. (2012). Summarizing activity limitations in children with chronic illnesses living in the community: A measurement study of scales using supplemented interRAI items. BMC Health Services Research. 12:19. DOI: 10.1186/1472-6963-12-19
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