All about interRAI… Len Gray April 2014
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 • • • • • • 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… 4 www.interrai.org 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 5 www.interrai.org This will need a meeting or two… • • • • • 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… 6 www.interrai.org A Compilation Assessment System The Data Items The Result • • • • • • • • • 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 7 www.interrai.org interRAI Design Principles • • • • • • • 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 8 www.interrai.org 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 13 www.interrai.org The interRAI Suite for vulnerable populations • • • • • • • • Long term care Assisted living Home care Community health Emergency department Acute care Post acute care Palliative care • • • • • 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 14 www.interrai.org 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 17 www.interrai.org 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
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