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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)

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introducing the interrai home care

Introducing theinterRAI Home Care

Talking the same language for effective care of older people

slide2

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

slide3

interRAI – Community Mental Health

Comprehensive Geriatric Assessment

& Care Planning

for Acute Care

interRAI – Community Health Assessment

Comprehensive Assessment

& Care Planning

for Acute Care

interRAI – Palliative Care

Comprehensive Assessment

& Care Planning

for Palliative Care

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

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

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

there is a suite of community instruments to suit organisational and individual client needs
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

slide5
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
The interRAI HC offers multi-dimensional assessment

interRAI HC

  • 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
interrai instruments support management of entire episodes of care not only admission assessment

Baseline assessment

Establish care plans

Admission profiling

Quality monitoring

Progress review

Re-assessment as needs change

Discharge plans

Standard review assessments

Outcome assessment

Discharge profiling

interRAI instruments support management of entire episodes of care, not only admission assessment

… one integrated systemreduces duplication, improves documentation & increases care quality.

a successful interrai hc implementation brings a wide array of benefits
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
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
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
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
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

Case Mix

Minimum

Data Set

Outcome

Measurement

Scales

Quality

Indicators

Care planning

protocols

The interRAI model

Assessment

clinical decision support interrai systems help clinicians to
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
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
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
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
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
Quality Indicators assist in assessing service performance
  • 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
  • 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
Something for everyone…
  • Clinicians
  • Service administrators
  • Planners and policy makers
implementation of an interrai instrument requires careful planning
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

Success

Three building blocks to success….

Clinical datasystems:

interRAI HC

Work

processes

Software

training is important
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
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
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

slide26

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)