May 2016
interRAI news
From the editor
Our big news this edition is the successful World interRAI Conference.  Canadian interRAI lead John Hirdes and his team deserve high praise for organizing a brilliant conference.
 
Alongside this meeting, interRAI Fellows held their first combined meeting for over two years.  The three key working groups (or "Networks") within interRAI are now Acute Care, Integrated Care and Ageing, and Mental Health.  Each group works across an array of systems and solutions, with oversight provided by the interRAI Instruments and Systems Development (ISD) Committee.  This network structure has expanded the Fellowship, and has accelerated production of new systems, some of which are featured in this edition of the Newsletter.

Prof. Len Gray
MBBS, MMed, PhD, FRACP, FACHSE, FAAG

World interRAI Conference a Resounding Success 
The first World interRAI Conference took place in Toronto, Canada from April 11th to 14th and was followed by a three-day meeting for interRAI Fellows. 

The conference attracted over 700 delegates from 30 countries. It was opened by Ontario's Deputy Premier Deb Matthews and included letters of greeting from Dr. Jane Philpott, Canada's Federal Minister of Health, and Dr. Eric Hoskins, Minister of Health and Long Term Care, Ontario. 

The conference featured over 170 podium presentations and almost 60 posters over a three-day period.  Pre-conference tours and training sessions were jointly offered by interRAI and the Canadian Institute for Health Information (CIHI). The conference co-chairs were John Hirdes (University of Waterloo, interRAI Canada) and Brent Diverty (CIHI),  and the Ontario Hospital Association served as the conference organizer. 

The conference featured five plenary sessions that highlighted interRAI's work across the continuum of care to identify and respond to the needs of vulnerable persons ranging from newborns to centenarians. An international panel of judges had the difficult task of selecting winners for Innovations Awards given for outstanding posters and podium presentations in several categories. The winners were: Matthew Leyenaar - Canada (Best Poster), Sebastian Rios - Canada (Best Poster Honourable Mention), New Zealand Implementation Team (Collaborative Effort), Raquel Betini - Canada (Student Award), Angelo Carfi - Italy (Podium Presentation), and Leon Geffen - South Africa (interRAI Fellow).  The next Canadian interRAI Conference will occur in 2018 and the next World interRAI Conference is planned for Europe in 2020.



Self-Reported Quality of Life Assessments
At the World interRAI Conference in Toronto this month, a panel of interRAI fellows discussed research findings using the new interRAI suite of Self-Reported Quality of Life (SQOL) assessments. Brant Fries addressed the significant overlap between the Home Care (HC) and Long-Term Care Facility (LTCF) instruments, with several items also shared with the Mental Health instruments.  A set of five scales can be derived from the Home Care instrument, representing respect, belonging, choice, privacy, and food as reported by Mary James.  For the LTCF, John Morris described five scales as well, including staff attentiveness, life meaning, food, caring staff, and personal control. Finally, John Hirdes discussed how his three scales - psychosocial resources, empowerment, and staff relations - address a recovery model for mental health.  The manual for the full suite of SQOL instruments is available through the interRAI website.

interRAI Hospital Suite Approaching Completion
Built on over 10 years of research and development, an entire suite of hospital systems is approaching completion.  

An international launch is planned in Brisbane, Australia, in February 2017 at a special conference that will focus on hospital care for frail and vulnerable adults across the hospital continuum.  Details of the conference will be provided in the forthcoming newsletter, and will be separately announced in a special dispatch in the next couple of months.

The suite will comprise a screener and short assessment system for the emergency department, a brief admission assessment system for all adult inpatients, and comprehensive assessment systems for patients with complex needs in acute, post-acute and rehabilitation settings.  The hospital suite is fully compatible with other interRAI systems, thus supporting communication and care planning across the hospital-community interface.

A detailed overview of the suite will be provided in the next Newsletter.

A special issue of Healthcare Management Forum (HMF) features eight articles focussed on interRAI mental health assessments. HMF is the official peer-reviewed journal of the Canadian College of Health Leaders. The special issue features articles on diverse mental health issues using data from the interRAI Mental Health (MH)Emergency Screener for Psychiatry (ESP)Brief Mental Health Screener (BMHS)Child and Youth Mental Health (ChYMH), and RAI-Home Care. The special issue is fully Open Access and includes a guest editorial by Edgardo Perez, a world-renowned authority in recovery, mental health, and addictions and a long-time supporter of interRAI.
 
In addition to the special feature issue, the publishers (SAGE) developed a 20-minute podcast featuring a conversation on the interRAI Mental Health instruments with insights from Edgardo Perez, Barbara Pizzingrilli and John Hirdes. interRAI Canada also developed a video highlighting the exciting contents of this special issue that includes interviews with authors and interRAI Fellows John Hirdes, Ron Hoffman, Krista Mathias and more.


Now Available: Case Mix Primer for Home-Based Services 
interRAI researchers at the University of Michigan recently completed work on a guide for policymakers seeking to understand the principles and applications of case mix for home and community-based services (HCBS). The Primer features real-world experiences of five states coming together to discuss common issues faced in designing and implementing case mix classification systems and payment approaches. While written for a US audience, the Primer explores issues of interest to any jurisdiction, including basic principles, measuring resource use, calculating allocations from case-mix weights, and implementation challenges. The interRAI bibliography provides a link to the electronic version of the report , which can be downloaded from the HCBS website.

Recent Publications

Comans TA, Peel NM, Hubbard RE, Mulligan AD, Gray LC, Scuffham PA. The increase in healthcare costs associated with frailty in older people discharged to a post-acute transition care program. Age Ageing. 2016.


Phillips C. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges. Health Services Insights. 2015.

Versleijen M, Martin-Khan MG, Whitty JA, Smith AC, Gray LC. A telegeriatric service in a small rural hospital: A case study and cost analysis. J Telemed Telecare. 2015.

Featured Publication: The CPS Updated

The Cognitive Performance Scale is one of interRAI's most mature and effective applications.  It is now over 20-years old. The assembly of a database of 3733 cases of interRAI assessments from a range of clinical settings in 8 nations with concurrent MMSE scores provided an opportunity to expand and refine the scale.  The CPS2 has a range of 0-8 (compared to 0-6).  There is more granularity at the lower end of the scale, and potential for the scale to be more responsive to change across time. The effort was led by John Morris. The code for the CPS2 is available in the website repository.
 
Morris JN, Howard EP,  Steel K, Perlman C, Fries BE, Garms-Homolova V, Henrard JC, Hirdes JP, Ljunggren G, Gray LC and Szczerbinska K: Updating the Cognitive Performance Scale. J Geriatr Psychiatry Neurol. 2016.

Child and Youth Mental Health and Developmental Disability (ChYMH-DD) Assessment System now Available
The interRAI Child and Youth Mental Health and Developmental Disability (ChYMH-DD) Assessment System is a comprehensive, multidisciplinary mental health assessment system for use with children and youth between the ages of 4 and 18 years who have developmental disabilities for community-based as well as in-patient and residential services. The ChYMH-DD Assessment System assesses psychiatric, social, environmental, and medical issues emphasizing a child's or youth's functioning, with applications for assessing risk, planning individualized care, measuring outcomes, predicting resource utilization, and evaluating quality. Specific items in the ChYMH-DD Assessment System provide triggering algorithms for Collaborative Action Plans (CAPs) that flag children and youth with potential problems in need of further clinical review (for example, additional assessment, treatment, or recommendations). Available here.
New interRAI Manuals in 2016



Self-Reported Quality of Life (QOL) Surveys and User's Manual, 9.3

The goal of QOL Surveys is to determine how persons served in a variety of programs and settings experience day-to-day life and assess the services they receive. The surveys focus on issues that generally are not covered in depth in the interRAI integrated suite of clinical assessment instruments, including the person's perspective on autonomy, privacy, comfort, relationships, and meaningful activities. 

BMHS for Front-line Police & Community Service Providers

The  interRAI Brief Mental Health Screener (BMHS) Assessment Forms and User's Manual: A Screening Level Assessment for Use by Police Officers and Other Front-line Service Providers is now available. Developed to assist front-line police officers and community service providers to identify and respond to persons with mental health concerns, it is designed as a brief screener only, with two versions of the form.  
 
ChYMH-DD Assessment Form and User's Manual: 9.3 

Introducing the interRAI Child and Youth Mental Health and Developmental Disability (ChYMH-DD) Assessment Form and User's Manual: For use with In-patient and Community-Based Assessments, 9.3. The third manual in the ChYMH series, it is intended to be used with children and youth with developmental disabilities in mental health settings to support comprehensive care planning and more.