1. Enhancing the quality of care for institutionalized older persons through the use of a minimum data set
Leon Geffen MBChB FCFP(SA).
The Albertina and Walter Sislulu Institute of Ageing in Africa, L51 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, South Africa
Highlands House, Jewish Aged Home, Cape Town, South Africa

2. Lack of Information about Older Persons in Africa…
Needs of older Persons
Effectiveness of service delivery
Resource Allocation
Quality of care rendered
Diagnoses
Functional status
Medical complexity
Mental Health
Psychosocial well being

3. What is InterRAI
Collaborative network of researchers in over 30 countries
Committed to improving health care for persons who are elderly, frail, or disabled.
Promote evidence-based clinical practice and policy decisions through the collection and interpretation of high quality data about the characteristics and outcomes of persons served
Internationally validated – over 550 peer reviewed publications

4. South America Brazil, Chile
interRAI Countries
Europe
Iceland, Norway, Sweden, Denmark, Finland, Netherlands, France, Germany, Switzerland, UK, Italy, Spain, Czech Republic, Poland, Estonia, Belgium, Lithuania,
Portugal, Austria, Russia
North America Canada US
Mexico
Central/
South America Brazil, Chile
Peru
Pacific Rim
Japan, China, Taiwan,
Hong Kong, South Korea,
Australia, New Zealand
Singapore
South Asia, Middle East & Africa India, Israel, Lebanon Ghana, South Africa

5. interRAI Suite of Assessment Instruments
interRAI has created a multi-domain suite of assessment instruments, providing a common language to describe persons across sites of care
The instruments support assessment and care planning in
aged care,
mental health, and
disability services
Morris JN. Measuring Quality Outcomes accessed 5 Oct 2012

6. interRAI Suite of Assessment Instruments
Each assessment instrument has:
Items common to other instruments – e.g., ADLs, cognitive function, mood, pain, falls,
As well as specialized items that are exclusive to that setting __ e.g., suicide and criminality items in the mental health tool
Morris JN. Measuring Quality Outcomes accessed 5 Oct 2012

7. Assisted
Living
Home
Care
Long term
Community
Health
Mental
Quality of Life
Palliative
Post Acute
Core
Items

8. The interRAI family of instruments
Mental Health
Inpatient
Community
Emergency Screener
Forensic Supplement
Child & Youth
Correctional Facilities
Brief Mental Health Screener
Community Health Assessment
Functional supplement
Mental Health supplement
Deafblind supplement
Assisted Living supplement
Intellectual Disability
Home Care
Contact Assessment
Nursing Homes, Complex Continuing Care Hospitals
Acute Care
ED Screener
Palliative Care
Post-Acute Care-Rehabilitation
Subjective Quality of Life
Long term care
Home and community care
Mental Health

9. Why are interRAI Assessments Different?
Developed by international panel of experts: geriatrics, gerontology, assessment, and health services research
Carefully tested psychometric properties
New design: assessment driven decision-making at all levels, from clinical to policy
Collect data once, use many ways
Develop compatible systems across health care sectors

10. InterRAI – Long Term Care Facility
Comprehensive, standardized instrument for evaluating the needs, strengths, and preferences of those in chronic care and nursing home institutional settings.
Promotes a person-centered approach to care
Consists of an assessment form, item-by-item instructions, and a series of care planning protocols.

11. interRAI – Resident Assessment Instrument
Minimum Data Set (MDS)
Core assessment items required for comprehensive assessment
Resident Assessment Protocols (RAP’s)
Guidelines for additional focused care
Triggered by individual MDS responses
Problem conditions
Mood, incontinence
Risk factors for decline
Dizziness, wandering, use of restraints, use of drugs, risk of falls
Potential for improved function
Person believes that they may achieve independence if a problem is addressed e.g. Hearing assessed to improve communication

12. InterRAI Domains Assessed
Cognition & Mental Health
Social Life
1. Activities
2. Informal support
3. Social relationship
1. Cognitive loss
2. Delirium
3. Communication
4. Mood
5. Behaviour
6. Abusive relationships
Falls
Pain
Pressure ulcer
Cardiorespiratory
Undernutrition
Dehydration
Feeding tube
Prevention
Appropriate medication
Tobacco and alcohol
Urinary incontinence
Bowel conditions
1. Physical activities
2. IADL’s
3. BADL’s
4. Home environment
5. Institutional risk
6. Physical restraints
Clinical Issues
Functional Performance

13. How does the data help
Useful information about well being of individuals
Individualised care plans
Ability to track resident’s functional status over time
Allows evidence based decision making
Comparing quality in the facility over time
Comparing differences between facilities

14. Uses of InterRAI Instruments
care planning,
facility management,
needs assessment,
policy development,
quality improvement and benchmarking,
reimbursement,
research,
service eligibility

15. Public Accountability
Applications of interRAI Instruments: One assessment … multiple applications
Case-mix
Single Point Entry
Care Plan
Resource Allocation
Evaluate
Best Practices
Assessment
Prevent Gaming
Outcome Measures
Quality Indicators
Patient Safety
Quality Improvement
Public Accountability
Accreditation

16. MADRID INTERNATIONAL PLAN OF ACTION ON AGEING
Organizing a needs assessment, including the types of questions to ask different stakeholders;
Establishing monitoring and evaluation procedures and benchmarks.
New Zealand Model
Implementation of interRAI tools