The interRAI Suite of Assessment Tools: Opportunities for Integration Across the Service Spectrum

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The interRAI Suite of Assessment Tools
Opportunities for Integration Across the
Service Spectrum

• Mary L. James
• Fellow, interRAI
• Assistant Research Scientist
• University of Michigan
• LTC HIT Summit
• June 9, 2006

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The current state of HIT in the US
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What is interRAI?

• Consortium of researchers, clinicians, and
  policymakers
• Mission use assessment to understand and improve
  care of persons with long term health needs
• Currently 45 members
• Provide instruments at no charge to agencies and
  governments royalty for vendors
• All Fellows are volunteers-no paid staff

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interRAI Countries
Nordic Countries Iceland, Norway, Sweden,
Denmark, Finland
Europe Netherlands, Germany, Switzerland,
France, UK, Italy, Spain, Czech Republic,
Poland, Estonia
North AmericaCanada US
Pacific Rim Japan, China, Taiwan, Hong Kong,
South Korea, Australia, New Zealand
Middle East Israel
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Development Process forinterRAI Instruments

• Identify key clinical issues
• Develop assessment protocols
• Conduct clinical studies
• Conduct reliability validity trials
• Implement in clinical settings
• On-going evaluation refinement

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Key Elements of interRAI Tools

• Use all possible information sources
• Include full definitions, time delimiters
• Include examples, exclusions
• Cover essential domains
• individuals strengths and weaknesses
• tradeoff of breadth and length
• Carefully test psychometric properties
• Support with training manuals, website, ongoing
  research

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Structure of interRAI Tools

• Three parts
• Minimum Data Set
• Triggers
• Clinical Assessment Protocols (CAPs)

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interRAI Assessment DomainsHome Care Tool

• Cognition
• Communication
• Vision
• Mood and behavior
• Social functioning
• ADLs/IADL function
• Continence
• Current disease diagnoses
• Health Conditions

• Preventive health measures
• Nutrition and hydration
• Oral/dental status
• Skin condition
• Informal social support
• Environmental/home safety
• Service utilization
• Medications
• Socio-demographics

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What are CAPs?

• Identify possible additional assessment or
  intervention needs
• Cover issues that are common in target population
  or pose a severe risk
• Help both clinicians and participants to focus on
  key issues
• Not intended to automate care planning!

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Clinical Assessment ProtocolsHome Care Tool

• Functional Performance
• ADL rehab potential
• IADLs
• Health promotion
• Institutional risk
• Sensory Performance
• Communication disorders
• Visual function
• Mental Health
• Alcohol dependence/hazardous drinking
• Cognition
• Behavior
• Depression and anxiety
• Elder abuse
• Social function
• Continence
• Bladder management
• Urinary incontinence

• Health problems/syndromes
• Cardio-respiratory
• Dehydration
• Falls
• Nutrition
• Oral health
• Pain
• Pressure ulcers
• Skin and foot conditions
• Service oversight
• Adherence
• Brittle support systems
• Medication management
• Palliative care
• Preventive health measures
• Psychotropic drugs
• Reduction in formal services
• Environmental assessment

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Major Applications of interRAI Tool Data

• Care Planning
• Profiling/Program Evaluation
• Resource Allocation
• Quality of Care
• Screening/Eligibility Determination
• Program Administration
• Research

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States Using interRAI Home Care
?
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Collaborative Effort with CCRCs

• www.collageaging.kendal.org

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interRAI Instrument Adoption in Canada
RAI 2.0 RAI-HC RAI-MH interRAI-CMH interRAI-ESP in
terRAI-PC interRAI-ID interRAI-ER/AC interRAI-CA i
nterRAI-CHA interRAI-AL
Solid symbols mandated or recommended by govt
Hollow symbols research/evaluation underway
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National Reporting Systems-Canada

• Canadian Institute for Health Information (CIHI)
  acts as national data repository
• Continuing Care Reporting System
• Based on RAI 2.0
• Home Care Reporting System
• Based on RAI-HC
• Ontario Mental Health Reporting System
• Based on RAI-MH
• Will be expanded to national level after Ontario
  implementation

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2005 interRAI Suite

• Well Elderly
• Home Care
• Assisted Living
• Nursing Home
• Post-acute care
• In Development
• Persons with Disabilities
• Pediatric Care

• Palliative Care
• Acute Care
• Inpatient Mental Health
• Community Mental Health
• Intellectual Disabilities

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Integration of interRAI Tools-I

• Phase One review all instruments
• Categorize items
• Core
• Optional
• Instrument-specific
• Items that did not work

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Integration of interRAI Tools-II

• Phase Two harmonize
• Review measurement properties
• Refinement to single standard wording for each
  item to appear in all instruments
• Specification of code responses for standardized
  items
• Removal of all references to client, patient,
  resident
• Standard is now person
• Use of three day observation (assessment) period

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Integration of interRAI Tools-III

• Phase Three redesign all instruments
• Each instrument committee incorporated Core
  items, added appropriate Optional items
• Instrument forms approved in draft in 2003
• Went into the field with a wide-ranging,
  cross-national trial

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Integration of interRAI Tools-IV

• Phase Four analysis
• Field test completed
• Analysis of the distributional properties of the
  items did new items behave as expected?
• Reliability of items established
• Debriefed clinicians and used feedback in further
  refinement

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CAPs Refinement

• Used nursing home and home care data from around
  world
• models developed to ensure that right persons
  are triggered for care
• instances where intervention might make real
  difference in persons life
• In this process, interRAI reduced number of
  problems triggered for average NF resident by 45
  

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Measures in the New Suite

• interRAI included items required to score
• CMS Quality Indicators
• RUG III system
• CAPS
• Many established scales based on earlier
  generation of assessment instruments (e.g., CPS,
  DRS, Pain, ADLs)

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New Scales in Suite

• As a part of field trial, completed series of new
  validation studies
• New and refined scales resulted
• New delirium scale
• New self-report depression scale
• Refinements to a number of scales, including the
  Cognitive Performance Scale and Pain Scale

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Data Opportunities for Adopters

• Comparable data across
• settings
• programs
• multiple sites within a single program
• geographic regions
• time
• Large sample sizes (or full populations)
• Common language

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Next Steps and Big Issues

• Continue CAP trigger refinement
• Collaborate on CAPs?
• New training manuals
• Training is essentialwhat opportunities might
  there be to increase capacity?
• Computerization

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Contact Us

• mljames_at_umich.edu
• www.interrai.org