www.interrai.org introducing the interrai home care talking the same language for effective care of...
TRANSCRIPT
www.interrai.org
Introducing the
interRAI Home Care
Talking the same language for effective care of older people
www.interrai.org
interRAI has developed an entire range of instruments and screeners to support assessment in a wide array of community and institutional settings
INSTRUMENTS
• Long term care facility
• Assisted living (hostel)
• Home care
• Community health assessment
• Mental health
• Community mental health
• Acute care
• Post-acute care
• Palliative care
• Intellectual disability
INSTRUMENTS
• Long term care facility
• Assisted living (hostel)
• Home care
• Community health assessment
• Mental health
• Community mental health
• Acute care
• Post-acute care
• Palliative care
• Intellectual disability
SCREENERS• Self-reliance Protocol (community care)• Community & Hospital Intake Protocol (CHIP)• Emergency room*• Acute care*
* In development
SCREENERS• Self-reliance Protocol (community care)• Community & Hospital Intake Protocol (CHIP)• Emergency room*• Acute care*
* In development
interRAI specialises in aged care, disability and mental health services
www.interrai.org
The interRAI suite includes several instruments designed for application in community care…
The interRAI Home Care is the most widely used instrument applied in the community setting
interRAI – Community
Mental Health
Comprehensive Geriatric Assessment
& Care Planning
for Acute Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
International
Copyright interRAI, Washington
D.C., 2004
Minimum Data Set
Test Version 1.04
[Multi-column format]
International
Copyright interRAI, Washington
D.C., 2004
interRAI – Palliative Care
Comprehensive Assessment & Care Planning for Palliative Care
Minimum Data SetTest Version 1.04
[Multi-column format]International
Copyright interRAI, Washington D.C., 2004
Minimum Data SetTest Version 1.04
[Multi-column format]International
Copyright interRAI, Washington D.C., 2004
interRAI – Community Health AssessmentComprehensive Assessment & Care Planning for Acute Care
Minimum Data SetTest Version 1.04[Multi-column format]InternationalCopyright interRAI, Washington D.C., 2004
Minimum Data SetTest Version 1.04[Multi-column format]InternationalCopyright interRAI, Washington D.C., 2004
interRAI - Home Care
Comprehensive Geriatric Assessment
& Care Planning
for Acute Care
Minimum Data Set
Test Version 1.04
[Multi-column format]
International
Copyright interRAI, Washington
D.C., 2004
Minimum Data Set
Test Version 1.04
[Multi-column format]
International
Copyright interRAI, Washington
D.C., 2004
www.interrai.org
There is a suite of community instruments to suit organisational and individual client needs
Entry from communityEntry from community
interRAI Self Reliance Screener
Complex care requirement?
interRAI CMHinterRAI PCinterRAI ID
interRAI HC
Specialist care requirement?
interRAI CHA
Yes
No
YesNo
www.interrai.org
The interRAI Home Care is designed as a general purpose assessment instrument for persons with complex care requirements
• It is now in its 3rd version (the interRAI HC)• Previous versions were the RAI-HC and RAI-HC 2.0
• It is used extensively in many areas of North America and Europe, and is currently being trialled in Australia and New Zealand
www.interrai.org
The interRAI HC offers multi-dimensional assessment
interRAI HCinterRAI HCScreening • Delirium• Dementia• Malnutrition• Depression
Screening • Delirium• Dementia• Malnutrition• Depression
Risk assessment• Delirium• Falls• Functional decline• Pressure ulcer• Rehab. potential• Need for services
Risk assessment• Delirium• Falls• Functional decline• Pressure ulcer• Rehab. potential• Need for services
Severity measures• Cognitive performance• Communication• Depression• Activities of daily living• Instrumental ADL• Pain• Health stability
Severity measures• Cognitive performance• Communication• Depression• Activities of daily living• Instrumental ADL• Pain• Health stability
Problem lists• Diagnoses• Geriatric syndromes• Social & environmental
Problem lists• Diagnoses• Geriatric syndromes• Social & environmental
www.interrai.org
interRAI instruments support management of entire episodes of care, not only admission assessment
Re-assessment as needs changeRe-assessment as needs change
Standard review assessmentsStandard review assessments
Admission profilingAdmission profiling
Discharge profilingDischarge profiling
… one integrated system reduces duplication,
improves documentation & increases care quality.
Discharge plansDischarge plans
Outcome assessmentOutcome assessment
Quality monitoringQuality monitoring
Baseline assessmentBaseline assessment
Progress reviewProgress review
Establish care plansEstablish care plans
www.interrai.org
A successful interRAI HC implementation brings a wide array of benefits…
• Integrated information systems across care settings
• Electronic information sharing• Improving clinical skills and standards• Consistent decision-making among clinicians
and agencies• Reduced documentation burden • Quality monitoring• Benchmarking among providers• Casemix evaluation
www.interrai.org
Reducing duplication in the Australian setting
• The interRAI HC contains sufficient information to meet most of the ACAT, HACC and ACCR data reporting requirements
• Once completed, with appropriate software, it can automatically fulfil this function eliminating much of the duplicate paperwork
www.interrai.org
interRAI assessment instruments are built to specific principles and standards
• Each assessment creates a minimum data set which provides an entire range of measures to assist in care planning, client monitoring and administration.
• High quality data is COLLECTED ONCE and then used for multiple purposes. • This encourages accuracy and reduces duplication
• All items are carefully crafted and tested across many countries to ensure good reliability and cultural appropriateness
www.interrai.org
• Profiling of cognitive, functional and psycho-social status including:
• Screening for common geriatric syndromes• Risk assessment for adverse events• Measuring severity of disability
• Identifying opportunities for prevention or improvement
• Assessment of quality of care being delivered• Evaluation of case complexity (casemix)
The interRAI HC performs many tasks - not just recording observations
www.interrai.org
The interRAI HC is not only a data set
It includes…• Data collection forms
• a set of clinical observations and measures
• A training manual• including definitions, case studies and clinical protocols
• Codesets• computer code to enable software to calculate scales, quality
indicators, clinical assessment protocols and casemix groupings
It is a “system” to support assessment, care planning, communication, quality monitoring and administration.
www.interrai.org
The interRAI model
Assessment
Minimum Data SetMinimum Data Set
OutcomeMeasurement
Scales
QualityIndicators
Case Mix
Care planning protocols
www.interrai.org
Clinical decision support:interRAI systems help clinicians to…
• Interpret observations• Organise information• Plan care• Monitor clinical progress
www.interrai.org
Logic systems are applied to assist clinicians to interpret their recorded observations
• These “algorithms” calculate scales, screeners, clinical assessment protocols (CAPs), quality indicators and casemix groupings
• The development of algorithms is based on extensive and ongoing research performed by interRAI…
• interRAI makes extensive use of clinical databases provided by user organisations to undertake this work
www.interrai.org
The clinical algorithms enable screening for common conditions…
Screeners and scales are validated against “gold standard” clinical assessment or best available existing tools
PRESENCE OF:• Dementia• Delirium• Depression• Malnutrition• Dehydration• Elder abuse• Social isolation
PRESENCE OF:• Dementia• Delirium• Depression• Malnutrition• Dehydration• Elder abuse• Social isolation
RISK OF:• Pressure ulcer• Falls • Institutionalisation
RISK OF:• Pressure ulcer• Falls • Institutionalisation
www.interrai.org
•Activities•Adherence•ADLs•Behaviour•Bladder•Bowel•Brittle support•Cognitive•Communication•Dehydration•Delirium
•Activities•Adherence•ADLs•Behaviour•Bladder•Bowel•Brittle support•Cognitive•Communication•Dehydration•Delirium
Clinical assessment protocols identify key issues for care planning
•Depression•Discharge•Drinking•Elder abuse•Environment•Falls•Feeding•IADL•Institutional risk•Nutrition•Oral
•Depression•Discharge•Drinking•Elder abuse•Environment•Falls•Feeding•IADL•Institutional risk•Nutrition•Oral
•Pain•Physical activity•Pressure ulcer•Prevention•Restraints•Skin care•Smoking•Social function•Unsettled relationship•Vision
•Pain•Physical activity•Pressure ulcer•Prevention•Restraints•Skin care•Smoking•Social function•Unsettled relationship•Vision
www.interrai.org
Scales assist in diagnostic screening and evaluating severity…
• ADL Hierarchy, Short & Long Form• IADL Capacity & Performance• Cognitive Performance Scale• Communication Scale • Depression Rating Scale• Pain Scale• Changes in Health End-stage disease Signs &
Symptoms of medical problems (CHESS) (Health stability)
• Body Mass Index
• ADL Hierarchy, Short & Long Form• IADL Capacity & Performance• Cognitive Performance Scale• Communication Scale • Depression Rating Scale• Pain Scale• Changes in Health End-stage disease Signs &
Symptoms of medical problems (CHESS) (Health stability)
• Body Mass Index
www.interrai.org
Quality Indicators assist in assessing service performance
Prevalence HCQIs•Inadequate meals•Weight loss•Dehydration•No medication review•Difficulty with mobility & no aids•Rehab potential & no treatment•Falls•Social isolation with distress•Delirium•Negative mood•Disruptive pain•Inadequate pain control•Neglect or abuse•Any injuries•No flu vaccination•Hospitalization
Prevalence HCQIs•Inadequate meals•Weight loss•Dehydration•No medication review•Difficulty with mobility & no aids•Rehab potential & no treatment•Falls•Social isolation with distress•Delirium•Negative mood•Disruptive pain•Inadequate pain control•Neglect or abuse•Any injuries•No flu vaccination•Hospitalization
Failure to improve HCQIs•Bladder incontinence•Skin ulcers•ADL impairment•Impaired mobility at home•Cognitive function•Difficulty in communication
Failure to improve HCQIs•Bladder incontinence•Skin ulcers•ADL impairment•Impaired mobility at home•Cognitive function•Difficulty in communication
www.interrai.org
Something for everyone…
• Clinicians
• Service administrators
• Planners and policy makers
•Caseload profiling•Better information for service planning•Ability to benchmark within and among service providers
•Improved productivity
•Improved clinical information•Electronic information sharing•Clinical decision support•Improved reliability & consistency•Reduced paperwork
•Caseload profiling•Ability to allocate resources among services and clients
•Service quality monitoring•Improved productivity
www.interrai.org
Implementation of an interRAI instrument requires careful planning
• The interRAI Home Care is one important building block to improving performance in community care…
• Consideration of other aspects of implementation may result in failure
• Organisations must consider: • how the instrument will be used; • who will perform assessments; • how often they will be repeated; • what reports are required – when and for whom; • how will training be conducted - for existing and future staff;• which software to use.
www.interrai.org
SuccessSuccess
Three building blocks to success….
Clinical datasystems:
interRAI HC
Clinical datasystems:
interRAI HC
Work processes
Work processes
Software
Software
www.interrai.org
Training is important…• Good training enables:
• A broad understanding of the interRAI approach and vision
• Detailed knowledge of item definitions and scoring leading to improved reliability
• Interpretation of scales, screeners and quality indicators
• Application of Clinical Assessment Protocols for care planning
• Use of software applications
www.interrai.org
How training is best delivered…• Small group, interactive format lead by a facilitator with
extensive clinical experience• Review of all clinical items aided by the HC manual• Interpretation of scales, Clinical Assessment Protocols and
screeners• Software utilisation • Interpretation of reports
Training requires approximately 3 days, which may be divided into 2 steps (2 + 1 days)
www.interrai.org
The interRAI HC is a powerful clinical tool that will…
• Support clinical evaluation
• Enable electronic communication
• Reduce duplication and paperwork
and…
IMPROVE THE QUALITY OF CARE
www.interrai.org
Talking the same language for
effective care of older people
www.interrai.org(International)
www.interrai-au.org(Australia)
For more information visit the interRAI websites