Using Big Data and Big Ideas to Improve the Health Care System John P. Hirdes, PhD FCAHS Professor School of Public Health and Health Systems University of Waterloo 1

Butterworths Series on Individual and Population Aging Series published between About 15 books published by leading gerontologists of the time Gerontology’s “coming of age” in Canada WF Forbes -Founding President Canadian Association and Ontario Gerontology Association -Vice-President of Gerontological Society of America -Mentor and PhD Supervisor Canadian Journal on Aging Special Issue on 25 th Anniversary of series 2

State of the Art in LTC Circa 1986 No national data for LTC beyond age and sex Had to cite small pilot studies for basic clinical information Called for implementation of standardized assessment systems But concerned that introduction of computers into LTC may be difficult Limited conceptualization of quality measurement Focus on survey based methods Could not conceive of QI based methods because standardized clinical information was far-fetched at the time Worried about adequacy of evidence for informing placement into long term care 3

What did we know about disability levels in Canadian nursing homes in 1986? 4

Implementation & Testing of interRAI Instruments 1996 Solid symbols – mandated or recommended by govt; Hollow symbols – research/evaluation underway RAI 2.0 5

6 RAI 2.0/ interRAI Long Term Care Facilities RAI-Home Care RAI-Mental Health interRAI Community Mental Health interRAI Emergency Screener for Psychiatry interRAI Brief Mental Health Screener interRAI Child/Youth Mental Health interRAI Intellectual Disability interRAI Palliative Care interRAI Acute Care/Emergency Department interRAI Contact Assessment interRAI Community Health Assessment interRAI Subjective Quality of Life Use of interRAI Instruments in Canada Solid symbols – mandated or recommended by govt; Hollow symbols – research/evaluation underway

National Reporting Systems Canadian Institute for Health Information acts as national data repository Continuing Care Reporting System (CCRS) Based on RAI 2.0 Home Care Reporting System (HCRS) Based on RAI-HC and interRAI Contact Assessment (incl ED Screener) Mental Health Reporting System (OMHRS) Based on RAI-MH Also supporting interRAI CMH & MH implementation in NFLD and Manitoba 7

8 interRAI Canada by the numbers (Based on CIHI Reporting Systems only to Dec 2014) 10 provinces and territories use interRAI instruments (9 mandated, 1 pilot) 15 Canadian researchers formally appointed to interRAI international network 18 years of data collection to date (no end date planned) 45 graduate theses (19 PhD, 26 MSc) completed at UW so far 9,000 clinicians in 1,900 organizations use interRAI assessments 645,180 new in-person assessments annually 2,010,559 Canadians assessed in-person by end of ,610 in nursing homes & CCC hospitals 813,342 RAI-HC + 803,431 interRAI CA in home care 293,161 in mental health 8,729,360 in-person assessments by end of ,992,707 in nursing home & CCC hospitals 2,482,972 RAI-HC + 1,293,988 interRAI CA in home care 959,698 in mental health Over 3 Billion data points available to interRAI Canada researchers so far

Data data everywhere but not a thought to think. Theodore Roszak author of "The Making of a Counter Culture" Big data are not enough to transform health care. Big ideas tested with sound analytic methods should be the driving force for change. 9

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What Lies Ahead in the Future of Health Care in Canada? 11 interRAI data on dementia in Canada 2,870,430 assessments of 400,000+ persons with ADRD

We can improve the quality of long term care

yourhealthsystem.cihi.ca 13

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Rates of Antipsychotic Use Among Nursing Home Residents Age 65+ with Dementia by Mental Health Symptoms and Province 15

Rates of Antipsychotic Use Among Nursing Home Residents Age 65+ with Dementia by Mental Health Symptoms and Care Setting, Ontario Only 16

Moving from Home Care to Nursing Home Consider the LAST RAI-HC assessment compared with the FIRST RAI 2.0 assessment What can we learn about changes with LTC admission? How can home care and LTC homes collaborate to manage risk related to the transition? Used sample of 17,949 Ontario HC assessments linked to first RAI 2.0 assessments 17

Use of Restraints and Antipsychotics in Nursing Home by CPS Score When Person in Home Care 18

Implications? What does this mean for home care case managers placing a client into LTC home? Whose responsibility is quality of care after admission? Can HC and NH staff collaborate to improve quality of transitions? Can we get different sectors of health care to work together as a system? 19