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 AfricaHighlands House, Jewish Aged Home, Cape Town, South Africa

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

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

North AmericaCanada

USMexico

EuropeIceland, Norway, Sweden, Denmark, Finland, Netherlands, France, Germany, Switzerland, UK, Italy, Spain, Czech Republic, Poland,

Estonia, Belgium, Lithuania,Portugal, Austria, Russia

Pacific RimJapan, China, Taiwan,

Hong Kong, South Korea, Australia, New Zealand

Singapore

South Asia, Middle East & Africa

India, Israel, LebanonGhana, South Africa

interRAI Countries

Central/ South America

Brazil, ChilePeru

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 http://www.ilcsa.uct.ac.za/downloads/Dr_Morris.ppt accessed 5 Oct 2012

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 http://www.ilcsa.uct.ac.za/downloads/Dr_Morris.ppt accessed 5 Oct 2012

AssistedLiving

Hom

e C

are

Long term

Care

Community Health

MentalHealth

Quality of

LifePallia

tive

Care

Post AcuteCare

Core Items

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

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

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.

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

InterRAI Domains Assessed

Cognition & Mental Health

Social Life

Functional Performance

Clinical Issues

1. Cognitive loss2. Delirium3. Communication4. Mood5. Behaviour6. Abusive relationships

1. Physical activities2. IADL’s3. BADL’s4. Home environment5. Institutional risk6. Physical restraints

1. Activities2. Informal support3. Social relationship1. Falls

2. Pain3. Pressure ulcer4. Cardiorespiratory5. Undernutrition6. Dehydration7. Feeding tube8. Prevention9. Appropriate

medication10. Tobacco and

alcohol 11. Urinary

incontinence12. Bowel conditions

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

Uses of InterRAI Instruments

care planning, facility management, needs assessment, policy development, quality improvement and

benchmarking, reimbursement, research, service eligibility

Applications of interRAI Instruments:One assessment … multiple applications

Assessment

Care Plan

Outcome Measures Quality Indicators

Resource Allocation

Prevent GamingEvaluate

Best Practices

Case-mixSingle Point Entry

Patient SafetyQuality ImprovementPublic Accountability

Accreditation

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