Introducing the interRAI Home Care Talking the same language for effective care of older people

interRAI has developed an entire range of instruments and screeners to support assessment in a wide array of community and institutional settings SCREENERS Self-reliance Protocol (community care) Community & Hospital Intake Protocol (CHIP) Emergency room* Acute care* * In development 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 interRAI specialises in aged care, disability and mental health services

interRAI – Community Mental Health Comprehensive Geriatric Assessment & Care Planning for Acute Care Minimum Data Set Test Version 1.04 [Multi-column format] Copyright interRAI, Washington D.C., 2004 International interRAI – Palliative Care Comprehensive Assessment & Care Planning for Palliative Care Minimum Data Set Test Version 1.04 [Multi-column format] International Copyright interRAI, Washington D.C., 2004 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 Health Assessment Comprehensive Assessment & Care Planning for Acute Care Minimum Data Set Test Version 1.04 [Multi-column format] Copyright interRAI, Washington D.C., 2004 International interRAI - Home Care Comprehensive Geriatric Assessment & Care Planning for Acute Care Minimum Data Set Test Version 1.04 [Multi-column format] Copyright interRAI, Washington D.C., 2004 International

There is a suite of community instruments to suit organisational and individual client needs Entry from community interRAI Self Reliance Screener Complex care requirement? Yes No Specialist care requirement? No Yes interRAI CMH interRAI PC interRAI ID interRAI CHA interRAI HC

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

The interRAI HC offers multi-dimensional assessment Screening Delirium Dementia Malnutrition Depression Problem lists Diagnoses Geriatric syndromes Social & environmental Severity measures Cognitive performance Communication Depression Activities of daily living Instrumental ADL Pain Health stability Risk assessment Delirium Falls Functional decline Pressure ulcer Rehab. potential Need for services

Re-assessment as needs change Standard review assessments interRAI instruments support management of entire episodes of care, not only admission assessment Discharge plans Outcome assessment Quality monitoring Baseline assessment Progress review Establish care plans Re-assessment as needs change Standard review assessments Admission profiling Discharge profiling … one integrated system reduces duplication, improves documentation & increases care quality.

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

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

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

The interRAI HC performs many tasks - not just recording observations 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 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.

The interRAI model Assessment Case Mix Outcome Minimum Measurement Data Set Outcome Measurement Scales The other compelling reason why governments have increasingly adopted MDS is because the instrument is multi faceted. It can be used for : Care Planning, improving quality, developing case mis and funding, outcome scales. I will explain each of these in a little more detail. Firstly let me gein with the MDS data itself…next slide Care planning protocols Quality Indicators

Clinical decision support: interRAI systems help clinicians to… Interpret observations Organise information Plan care Monitor clinical progress

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

The clinical algorithms enable screening for common conditions… PRESENCE OF: Dementia Delirium Depression Malnutrition Dehydration Elder abuse Social isolation RISK OF: Pressure ulcer Falls Institutionalisation Screeners and scales are validated against “gold standard” clinical assessment or best available existing tools

Clinical assessment protocols identify key issues for care planning Activities Adherence ADLs Behaviour Bladder Bowel Brittle support Cognitive Communication Dehydration Delirium 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

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

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 Failure to improve HCQIs Bladder incontinence Skin ulcers ADL impairment Impaired mobility at home Cognitive function Difficulty in communication

Something for everyone… Improved clinical information Electronic information sharing Clinical decision support Improved reliability & consistency Reduced paperwork Clinicians Service administrators Planners and policy makers Caseload profiling Better information for service planning Ability to benchmark within and among service providers Improved productivity Caseload profiling Ability to allocate resources among services and clients Service quality monitoring Improved productivity

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.

Three building blocks to success…. Clinical data systems: interRAI HC Work processes Software

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

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)

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

Talking the same language for effective care of older people For more information visit the interRAI websites www.interrai.org (International) www.interrai-au.org (Australia)