Introducing the

interRAI Home Care

Talking the same language for effective care of older people

www.interrai.org

interRAI has developed an entire range of instruments and screeners to support assessment in a wide array of community and institutional settings interRAI specialises in aged care, disability and mental health services

www.interrai.org

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 – 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 www.interrai.org

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

Entry from community interRAI Self Reliance Screener No interRAI CHA Complex care requirement?

Yes Specialist care requirement?

No interRAI HC Yes interRAI CMH interRAI PC interRAI ID www.interrai.org

The interRAI Home Care is designed as a general purpose assessment instrument for persons with complex care requirements

• It is now in its 3 rd • 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 www.interrai.org

The interRAI HC offers multi-dimensional assessment interRAI HC Problem lists

• Diagnoses • Geriatric syndromes • Social & environmental

Screening

• Delirium • Dementia • Malnutrition • Depression

Risk assessment

• Delirium • Falls • Functional decline • Pressure ulcer • Rehab. potential • Need for services

Severity measures

• Cognitive performance • Communication • Depression • Activities of daily living • Instrumental ADL • Pain • Health stability www.interrai.org

interRAI instruments support management of entire episodes of care, not only admission assessment Admission profiling Re-assessment as needs change Standard review assessments Discharge profiling

Baseline assessment Establish care plans Quality monitoring Progress review Discharge plans Outcome assessment …

one integrated system

reduces duplication, improves documentation & increases care quality.

www.interrai.org

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 www.interrai.org

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 www.interrai.org

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 www.interrai.org

• • • •

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) www.interrai.org

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.

www.interrai.org

The interRAI model

Assessment Minimum Data Set Care planning protocols Case Mix Outcome Measurement Scales Quality Indicators www.interrai.org

Clinical decision support: interRAI systems help clinicians to…

• • • •

Interpret observations Organise information Plan care Monitor clinical progress

www.interrai.org

• • •

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

www.interrai.org

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 www.interrai.org

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 www.interrai.org

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 www.interrai.org

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

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 www.interrai.org

Something for everyone…

• Clinicians • Service administrators • Planners and policy makers •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 www.interrai.org

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.

www.interrai.org

Three building blocks to success….

Work processes Success Clinical data systems: interRAI HC Software

www.interrai.org

•

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 www.interrai.org

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)

www.interrai.org

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 www.interrai.org

Talking the same language for effective care of older people

visit the interRAI websites

www.interrai.org

(International)

www.interrai-au.org

(Australia)

www.interrai.org