All about interRAI…
Len Gray
Coordinator, interRAI Network of Excellence in Acute Care
April 2014
www.interrai.org
The interRAI research collaborative
Australia
Belgium
Canada
Chile
China
Czech Republic
Denmark
Estonia
Finland
France
Germany
Hong Kong
Iceland
India
Israel
30+ nations
80+ clinicians &
scientists
Italy
Japan
Lithuania
New Zealand
Netherlands
Norway
Poland
South Korea
Spain
Sweden
Switzerland
Taiwan
United Kingdom
United States of America
www.interrai.org
Improving care of people with cognitive
impairment in hospital
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Case identification is critical…
We need to identify patients with delirium and dementia
Let’s select best of breed screening tools
Who to complete?
What about nurses?
Yes good idea… it only will need 5-10 minutes…
• Introduce a CAM and AMT into the nursing intake protocol…
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Wait a minute…
• There are other critical geriatric syndromes and functional
issues that we should identify…
• Undernutrition
• Depression
• ADL impairment
• And of course there are risks to be identified…
• Falls
• Pressure ulcer
• Let’s search the literature for best of breed diagnostic and
risk screening tools
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www.interrai.org
This will need a meeting or two…
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Let’s create a TWO PIZZA ASSESSMENT SYSTEM
Organise the key stakeholders with Pizzas
Select best of breed screeners
Fill in the gaps with some items we make ourselves
Reduce the font size to keep it to less than 4 pages to
minimise the workload for nurses
• Present the product to key stakeholders over PIZZA
• MISSION ACCOMPLISHED…
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A Compilation Assessment System
The Data Items
The Result
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• Inconsistent scoring
methods
• Item duplication
• Training challenges
• IT unfriendly
• Significant documentation
burden
• Poor compliance
CAM
AMT
Hamilton DRS
MNA
Waterlow
Katz ADL
FRAT
Various fillers to meet
nursing requirements
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interRAI Design Principles
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Build assessment systems from the ground up
Fit for purpose for each clinical context
Standardised item design
Collect data once and use for multiple purposes
Share “core items and scalar measures” across settings
Design for the digital era
Robust item and application testing across multiple nations
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Diagnostic &
risk screening
Clinical
observations
Indications for
clinical
intervention
Outcome
measurement
scales
Quality
indicators
Clinical
summaries
Case mix
www.interrai.org
The interRAI Acute Care
Diagnostic
screeners
Delirium
Dementia
Depression
Malnutrition
Clinical
observations
Risk assessment
Severity measures
Recommendations
(CAPs)
Quality indicators
Delirium
Cognition
Communication
Mood
ADL
IADL
Pain
Nutrition
Self care, mobility,
IDC, falls, pressure
ulcer, institutional
placement
Delirium
Pressure ulcer
Falls
Functional decline
Institutional care
Readmission
ADL
Cognition
Communication
Delirium
Depression
Pain
Pressure ulcer
Institutional risk
Readmission
Medications
www.interrai.org
The Hospital Journey
ED
CAM
AMT
Acute Care
CAM
MMSE
Waterlow
FRAT
MNA
Post - Acute Care
FIM
MMSE
GDS
Post - Acute
Community
Care
Barthel
MMSE
Result:
Inconsistent data format; high documentation burden;
poor compliance; no data sharing
www.interrai.org
The interRAI
Hospital Mini-Suite
Emergency
Department
Standalone
Screener
Acute Ward
Post Acute Ward
Post Acute
Community
interRAI AC
interRAI PAC
interRAI HC
Acute Care CAPs
Post-acute Care
CAPs
Home Care CAPs
Need for CGA
Assessment
tools
interRAI ED
Derivative measures
Clinical Assess’t Protocols
Setting specific
Severity measures
Multi-setting
Diagnostic screeners
Setting specific
Risk screeners
Setting specific
Quality indicators
Setting specific
General: Function, Frailty
Specific : Cognition, Communication, ADL, IADL, Pain, Nutrition
Delirium, Dementia, Malnutrition, Depression
Delirium, Falls, Pressure Ulcer
Outcome QIs
www.interrai.org
GENERAL
ASSESSMENT
SPECIALIST GERIATRIC
ASSESSMENT
interRAI ED Screener
2014
interRAI ED CA
2014
Ward Admission
Assessment
interRAI AC
2009
General ward
geriatric care
interRAI AC-PAC
2015
interRAI HC
2005
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The interRAI Suite for vulnerable populations
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Long term care
Assisted living
Home care
Community health
Emergency department
Acute care
Post acute care
Palliative care
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Mental health
Community mental health
Child and youth mental health
MH for correctional facilities
Child and youth intellectual
disability
• Intellectual disability
• Deaf blind
• Quality of life
• Wellness
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CI in hospital: What can interRAI offer?
• Robust screening for cognitive impairment and delirium as
part of an integrated system of care
• Comprehensive assessment of all functional & psychosocial
needs for complex cases
• Clinical protocols for intervention sensitive subpopulations
• Casemix adjustment accounting for cognitive and physical
function
• Quality indicators
• Continuity across the hospital – community pathway
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interRAI in action
www.interrai.org
Websites...
CRGM
www.som.uq.edu.au/research/crgm
interRAI Australia
www.interrai-au.org
RAIplus
www.raiplus.com
CeGA Online
www.cegaonline.com
www.interrai.org