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interRAI Newsletter                    
Issue 13 - June 2013

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Len Gray
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From the Editor

 

 

Recently, interRAI released a new publication for the interRAI Acute Care Assessment System. This publication assembles all of the derivative applications of an assessment system: scales, screeners, clinical protocols, and quality indicators. Similar "companion" manuals to the various instrument User's Manuals will be prepared for other instruments in the future.

 

Yet another nation-Ireland-has taken a major step forward towards adoption of multiple assessment systems on a large scale. This decision was taken after a process of diligent review of candidate instruments and field testing. 

 

interRAI continues to review its internal processes for instrument development and quality control. Several articles in this newsletter reflect aspects of these improved development processes. 

 

 

 

 

 

Len Gray

Editor, interRAI

 

 

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News

 

 

interRAI Releases First Complete Instrument "Applications Manual": The interRAI Acute Care Clinical and Management Applications Manual

 

 

A couple of weeks ago, development of the interRAI Acute Care (AC) Assessment System made an important step forward with the publication of the interRAI Acute Care Clinical and Management Applications Manual.This manual brings together all of the derived applications of the interRAI AC Assessment System, including:

 

�       Scales to measure problem severity, such as the cognitive performance scale, ADL hierarchy scale, and pain scale.

�       Diagnostic and risk screening tools for common geriatric syndromes, such as delirium, dementia, under-nutrition, falls, institutional care, and hospital readmission.

�       Algorithms to generate problem lists.

�       Clinical action points to target patients requiring specific preventive or treatment strategies.

�       Quality indicators to evaluate care delivery.

 

There is also a case study and some illustrations of clinical profiling.

 

As a result of its review of the manual since its recent review, the Instrument Systems Development (ISD) group decided to adopt it as a prototype for similar publications across the suite. 

 

This work has been guided by the interRAI AC working group within the interRAI Network of Excellence in Acute Care (iNEAC). This working group meets monthly by teleconference and of course, in person, whenever iNEAC meets.

 

The group believes that the applications of the interRAI AC are the most appealing aspect of the instrument to clinicians. It is hoped that by publishing the complete instrument, there will be enhanced interest and wider adoption.

 

Fellows can access the manual via the "Buy Books" section of the interRAI Web site at http://catalog.interrai.org/. interRAI Fellows (on application) may purchase books in small quantities at a discounted price if they are to be used for demonstration and marketing purposes. 

 
  
 
interRAI AC manual

 

New Process for Instrument Development

 

 

The interRAI Board has established a new process to support the development and approval of interRAI assessment systems. The Instrument and Systems Development Committee administers the process on behalf of the interRAI Board. All new instruments will now follow this three-stage development process:

 

Alpha

This is a preliminary stage of development, which may vary from a concept to a well-developed item set and list of potential applications. The purpose of ISD scrutiny and approval at this early stage is to ensure that the system is compatible with the existing suite and is consistent with interRAI's overall development plan.

 

Beta

The system is developed to a final item set, based on consultation with experts, field testing for psychometric properties and feasibility, and determination of scales, CAPs, and other applications. Beta systems will be listed on the interRAI Web site and available for general use.

 

Final

The system is complete with a Data Form, User's Manual, and applications including (at a minimum) scales and CAPs, but preferably with quality indicators and casemix applications. It is expected that a User's Manual will be published and that an Applications Manual is being developed. Final code will be available to interRAI members, vendors, and researchers via the secure section of the interRAI Web site. 

 

 

Ireland Moves Towards Using interRAI for Older People and Leads the Development of an interRAI Carer Needs Assessment Supplement

  

 

In 2010 the Health Service Executive (HSE) set up a multiagency and multidisciplinary National Single Assessment Tool Working Group with the task of selecting, piloting, and recommending a Single Assessment Tool (SAT) for use with older people nationally. The initiative aimed to address Irish health and social care policy requirements for a national standardized needs assessment to better support integrated service delivery and best practice in older persons care  (See i, ii, iii).

 

During 2011 and 2012, Ireland conducted a mixed methodology pilot study to explore the usability, practicality, and acceptability of the interRAI new integrated suite of the Home Care and Long-Term Care Facilities Assessment Systems (Version 9.1). A total of 229 interRAI assessments were undertaken among older people by 47 health professionals in rural and urban sites covering acute care, community care, and long-term residential care settings. The survey strand results for clients (n = 68), health professionals (n = 45), and carers (n = 15) were overwhelmingly positive regarding the acceptability and value of using the interRAI assessment system in both rural and urban Irish clinical practice.

 

Currently, the HSE in Ireland is involved in a national project to use interRAI Home Care and Acute Care Assessment Systems. interRAI established a National Project Team to lead the implementation in the use of these assessment tools.

 

In a limited number of long-term residential care sites, the project will also examine the interRAI- Long-Term Care Facilities Assessment System to explore any future implementation of Resource Utilization Group outputs in Irish health care settings.

 

A phased implementation approach has been planned with Phase One (2013-2017) initially focusing on older people who have/may have more complex care needs that require a service response to support them to remain living at home, or alternatively, as required, to assist them in a move to an appropriate long-term residential care setting. 

 

In addition, the national implementation has secured a commitment to develop an interRAI Carer Needs Assessment Supplement in partnership with interRAI consortium to fully support older people remaining at home for as long as possible.

 

The implementation of the selected interRAI tools will underpin the future development of services for older people, providing a standardized base for the allocation and development of services to older people based on their assessed needs, and will enable learning opportunities on how the particular needs of older persons living with dementia can be met. The project will further deliver a mechanism to considerably improve the rigour of decisions made regarding provision of resources under the Nursing Home Support Scheme and the Home Care Package Scheme and/ or Home Help Scheme. 

 

Finally, the national implementation team in Ireland would be grateful if interRAI readers would share examples of best practice communications materials that were effective in their country during implementation.

 

To contact the national implementation team in Ireland, please email:  [email protected] (Project Manager)

  

  

i Department of the Taoiseach. (2006). Towards 2016. Ten-Year Framework Social Partnership Agreement 2006-2015. Government Publications Office Sun Alliance House, Molesworth Street, Dublin 2.

  

ii O'Neill, D. (2006). A Review of the Deaths at Leas-Cross Nursing Home 2002-2005. Dublin 2006, www.hse.ie/Publications.

  

 iii HIQA. (2009). National Quality Standards for Residential Care Settings for Older People in Ireland. Dublin. 

  

Successful iNEAC 4 Held in Leuven, Belgium, 2013

 

 

The fourth interRAI Network of Excellence in Acute Care meeting was held last month in Leuven, Belgium. iNEAC now comprises over thirty members, of whom twenty-four participated in this recent meeting. The primary focus of the meeting was the work of completing the entire hospital interRAI "mini-suite." The interRAI AC is complete with the publication of Data Forms, User's Manual, and Application Manual. The interRAI ED contact assessment is undergoing some refinement, including the development of a quick screener to identify individuals who require a full assessment in the ED or hospital. The focus of work in 2013 will be to complete the Post-Acute Care component of the AC-PAC instrument, inclusive of the Data Form, User's Manual, and Applications Manual. The group is aiming to complete the hospital mini-suite in 2014.

  

Test Datasets for interRAI Code

 

 

The University of Michigan group has now begun constructing datasets that can be used to test code that vendors and researchers create. While interRAI provides to licensed users the specifications for its scales, triggers, and algorithms on its private Web site, these datasets now provide a way to be assured that any use or transformation of that code is error free. The database contains feasible assessments with extreme variability in item responses, along with "gold-standard" calculations of scales and algorithms. In the future, interRAI contracts with vendors will include requirements to certify to users that their software is 100% accurate in calculating required scales and algorithms on this database. At this time, only a test database for the interRAI HC is available, but databases for other suite instruments will be available as soon as feasible. 

  

 

Canada's Largest Province Releases Its Report "Living Longer, Living Well," Outlining Its Seniors Strategy  

 

Canadians who are 65 and older (14.6% of the population) account for nearly half of the country's health and social care spending. In Canada, the delivery of health and social care services is a provincial responsibility. While each province has organized their health and social care systems differently, they all offer the provision of care to their citizens free at the point of service. All provinces are also grappling with unprecedented fiscal and demographic pressures, with their collective older population set to double over the next 20 years.

 

In January 2012, the minister of health of Canada's largest province, Ontario, announced its Action Plan for Health Care. The action plan cited the need for a Seniors Strategy that could establish sustainable best practices and policies at a provincial level to support the overall coordination of the delivery of health and social care services with an intense focus on enabling seniors to stay healthy and stay at home longer. 

  

Dr. Samir Sinha, director of geriatrics at Mount Sinai and the University Health Network hospitals in Toronto, Canada, and an Associate interRAI Fellow was appointed to lead the development and implementation of the Seniors Strategy in May 2012.

  

After spending the summer touring nineteen communities across the province and receiving input from over 5,000 older Ontarians, 2,500 care professionals and 1,000 caregivers, including all members of the interRAI Network for Excellence in Acute Care (iNEAC), a final report was issued to the minister that outlines a proposed vision to move the care of older Ontarians forward in the coming decades. 

  

The report also highlights the current use of interRAI tools in Ontario and the potential to advance their use across the care continuum moving forward. Other interRAI Fellows, and Associate Fellows in particular, had their work and thinking featured in the report: John Hirdes, Bruce Leff, Katherine Berg, George Heckman, and Andrew Costa. 

  

Overall, the report has been well received amongst the public, professionals, and the health care sector. The development of its Seniors Strategy has developed momentum as well across the rest of the country, which recently saw the premiers and health ministers from across the country agree to make the advancement as a collective of Seniors Care a new inter-provincial priority.

  

The full report, "Living Longer, Living Well" is now available in both English and French on the Ministry's Web site at:

  

English: 

http://www.health.gov.on.ca/en/common/ministry/publications/reports/seniors_strategy/

  

French: http://www.health.gov.on.ca/fr/common/ministry/publications/reports/seniors_strategy/default.aspx

 

 

Hong Kong Casemix Study for Home Care

 

The RAI-Hong Kong (HK) research team has been partnering with the Social Welfare Department of the HK Special Administrative Region Government and many non-profit organizations to carry out a casemix study for older adults in need of community care services (CCS) in HK. The objectives of this study are examining the application of Resource Utilization Groups (RUGs) of interRAI HC on community care for the elderly in HK and making recommendations on a casemix classification system on different care needs of elders for use in the pilot Scheme on Community Care Service Voucher for the Elderly-a new initiative in local CCS. 

 

This study will take 18 months to complete starting in March 2013 and ending in September 2014.  Dr. Terry Lum, director of Sau Po Centre on Ageing at the University of Hong Kong will lead the research team to complete the following tasks: (1) review the application of RUG-HC in different countries; (2) modify the RUG-HC to fit HK's unique situation (RUG-HK); (3) apply the RUG-HK on past-3-year CCS users in HK; (4) estimate the resources used and associated costs for each RUG using administration data from services providers; (5) verify the RUG-HK classification and related resources through utilization data collected from new CCS users; (6) recommend a suite of RUGs for local CCS users with moderate to severe level of impairment; (7) recommend the service content, service volume, and financial costs for CCS users in each RUG category; (8) recommend a mechanism/protocol on regular updating and adjusting on RUGs for the voucher service; and (9) examine and recommend ways to implement the protocol mentioned above, including its feasibility, cost-effectiveness and implications on manpower, information technology, and professional development.

 


Building Systems to Address Functional Decline and Dependence in Ageing Populations

 

 

interRAI Fellows Drs. Brant Fries and Harriet Finne-Soveri were highlighted speakers at a WHO Conference on "Building Systems to Address Functional Decline and Dependence in Ageing Populations," held in The Hague, Netherlands. The conference was led by Dr. John Beard, the director of the WHO Department of Ageing and Life Course. Fries discussed the use of interRAI-based data to measure outcomes more sensitively than the usual coarse measures of mortality, the presence of diseases, etc. Finne-Soveri discussed how the government of Finland is using interRAI data to develop national plans for the care of the elderly. WHO will be releasing a conference statement in the near future. One of the innovations of this conference was the work of an artist who documented graphically many of the major points made by conference participants. The picture [below] shows  Finne-Soveri and Fries with their respective sections of this graphic.

 

Building Systems to Address Functional Decline and Dependence in Ageing Populations

 

 

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New members and promotions
 

Katarzyna Szczerbińska, MD, PhD, Promoted to Associate Professor


Katya
On January 17, 2013, interRAI Fellow representative for Poland and ISD member Katarzyna Szczerbińska was promoted to Associate Professor of Medicine in the specialty of Geriatrics. On February 1, 2013, she was appointed to the position of Head of the Unit for Research on Aging Society and Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University, Krak�w, Poland. The unit's mission and tasks described in its charter involve  extensive research activities in the field of gerontology and geriatrics including public health issues like quality of life, quality of care, health education, and health promotion all in older people. 

 

For many years she worked as a physician in different health care settings for the elderly and long-term care institutions (Geriatric Department of Jagiellonian University Hospital, a geriatric clinic, nursing home and skilled nursing LTC facilities, and a palliative care institution).  Furthermore, Katarzyna has participated in several international projects as a co-coordinator (TEMPUS No. 3734/9 - in Health Promotion) and researcher (BIOMED2 - COPE, 5th FP- CLESA, 5th FP-EUROPHEN), all of which deal with problems of quality of life of the elderly and their caregivers.

 

She has also been a lecturer and researcher in the Health Promotion Department at the Institute of Public Health since 1994. Her areas of expertise are organization of long-term care with focus on health promotion and quality of care assurance.

 

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Forthcoming meetings
 

 

Don't Miss the 2013 Canadian interRAI Conference

 

On behalf of the Canadian interRAI Conference planning committee, we are pleased to invite you to submit a podium or poster presentation for consideration at the 2013 Canadian interRAI Conference.

 

The seventh Canadian interRAI Conference provides an important forum that brings together researchers, policymakers, and practitioners using the interRAI system of instruments in community and home care, residential/long-term care, acute care, assisted living, mental health care, and palliative care. These evidence-based electronic instruments capture client/patient assessment information that is used to support care planning and delivery, quality improvement, health system management, and policy development.

 

This year's conference is being held in Ottawa, Ontario, on October 7-10, 2013.

 

The committee encourages submissions from clinicians, researchers, educators, management, front line staff, and those responsible for policy development and planning who wish to share their knowledge, expertise, best practices, and strategies working with the interRAI system of instruments. This is an excellent opportunity to share expertise and best practices with colleagues from across Canada and abroad.

 

 

For the conference flyer, click here.

 

For more information on the Call for Presentations process and/or to submit a presentation for consideration, click here

 

Conference Web site: http://www.canadianinterrai.org/ 

Phone: 1-800-598-8002 x1357

Email: [email protected]   

 

interRAI conference - issue 12
 

 

 

  

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Recent publications

 

 

Cook RJ, Berg K, Lee KA, Poss JW, Hirdes JP, Stolee P. (2013).

Rehabilitation in homecare is associated with functional improvement and preferred discharge.

Archives of

Physical Medicine and Rehabilitation.DOI:10.1016/j.apmr.2012.12.024. [Epub ahead of print]

 

Leung A, Kwan CW, Chi I. (2013).  Residents with Alzheimer's disease in long-term care facilities in Hong Kong: Patterns of hospitalization and emergency room use. Aging and Mental Health. DOI:10.1080/13607863.2013.768211.

 

Lou VWQ, Chi I, Kwan CW, Leung A. (2012). Trajectories of social engagement and depressive symptoms among long-term care facility residents in Hong Kong.  Age and Ageing. DOI: 10.1093/ageing/afs159.

Travers C, Byrne G, Pachana N, Klein K, Gray L. (2013). Prospective observational study of dementia and delirium in the acute hospital setting. Intern Med J. 43(3):262-9. DOI: 10.1111/j.1445-5994.2012.02962.x.

 

 

 

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