Talking the same language for effective care of older people

Transcription

1 Introducing the interrai Home Care Talking the same language for effective care of older people

2 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 SCREENERS Self-reliance Protocol (community care) care) Community & Hospital Intake Protocol (CHIP) INSTRUMENTS Long term care facility INSTRUMENTS Long term care facility Assisted Assisted living living (hostel) (hostel) Home Home care care Community Community health health assessment assessment Community & Hospital Intake Protocol (CHIP) Emergency room* Acute care* Emergency room* Acute care* Mental health Mental health Community mental health Community mental health Acute care * * In In development Acute care Post-acute Post-acute care care Palliative care Palliative care Intellectual Intellectual disability disability interrai specialises in aged care, disability and mental health services

3 interrai Community Mental Health Comprehensive Geriatric Assessment & Care Planning for Acute Care Minimum Data Set Test Minimum Version Data 1.04 Set [Multi-column Test Version format] 1.04 [Multi-column International format] Copyright interrai, International Washington D.C., 2004 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 interrai Palliative Care Comprehensive Assessment & Care Planning for Palliative Care interrai Community Minimum Data Set Test Minimum Version Data 1.04 Set [Multi-column Test Version format] 1.04 [Multi-column Internationalformat] Health Assessment Copyright interrai, International Washington D.C., 2004 Copyright interrai, Washington D.C., 2004 Comprehensive Assessment & Care Planning for Acute Care Minimum Data Set Test Minimum Version Data 1.04 Set [Multi-column Test Version 1.04 [Multi-column format] International format] International interrai - Home Care Copyright interrai, Washington D.C., 2004 Copyright interrai, Washington D.C., 2004 Comprehensive Geriatric Assessment & Care Planning for Acute Care Minimum Data Set Minimum Data Set Test Test Version Version [Multi-column format] International International [Multi-column format] Copyright Copyright interrai, interrai, Washington Washington D.C., D.C.,

4 There is a suite of community instruments to suite organisational and individual client needs Entry Entry from from community community interrai Self Reliance Screener Complex care requirement? Yes No Specialist care requirement? No Yes interrai CHA interrai HC interrai CMH interrai PC interrai ID

5 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

6 The interrai HC offers multi-dimensional assessment Problem lists lists Diagnoses Geriatric syndromes Social Social & environmental interrai HC HC Screening Delirium Dementia Malnutrition Depression Risk Risk assessment Delirium Falls Falls Functional decline decline Pressure ulcer ulcer Rehab. Rehab. potential Need Need for for services Severity measures Cognitive performance Communication Depression Activities of of daily daily living living Instrumental ADL ADL Pain Pain Health Health stability

7 interrai instruments support management of entire episodes of care, not only admission assessment Admission profiling Re-assessment as as needs change Standard review assessments Discharge profiling Baseline Baseline assessment assessment Establish Establish care care plans plans Quality Quality monitoring monitoring Progress Progress review review Discharge Discharge plans plans Outcome Outcome assessment assessment one integrated system reduces duplication, improves documentation & increases care quality.

8 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

9 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

10 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

11 The interrai HC performs many tasks - not just recording observations Profiling of cognitive, functional and psychosocial 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)

12 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.

13 The interrai model Assessment Case Mix Minimum Data Set Outcome Measurement Scales Care planning protocols Quality Indicators

14 Clinical decision support: interrai systems help clinicians to Interpret observations Organise information Plan care Monitor clinical progress

15 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

16 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

17 Clinical assessment protocols identify key issues for care planning Activities Activities Adherence Adherence ADLs ADLs Behaviour Behaviour Bladder Bladder Bowel Bowel Brittle Brittle support support Cognitive Cognitive Communication Communication Dehydration Dehydration Delirium Delirium Depression Depression Discharge Discharge Drinking Drinking Elder Elder abuse abuse Environment Environment Falls Falls Feeding Feeding IADL IADL Institutional Institutional risk risk Nutrition Nutrition Oral Oral Pain Pain Physical Physical activity activity Pressure Pressure ulcer ulcer Prevention Prevention Restraints Restraints Skin Skin care care Smoking Smoking Social Social function function Unsettled Unsettled relationship relationship Vision Vision

18 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 in Health End-stage disease Signs & Symptoms of of medical problems (CHESS) (Health stability) Body Mass Index

19 Quality Indicators assist in assessing service performance Failure Failure to to improve improve HCQIs HCQIs Bladder Bladder incontinence incontinence Skin Skin ulcers ulcers ADL ADL impairment impairment Impaired Impaired mobility mobility at at home home Cognitive Cognitive function function Difficulty Difficulty in in communication communication Prevalence Prevalence HCQIs HCQIs Inadequate Inadequate meals meals Weight Weight loss loss Dehydration Dehydration No No medication medication review review Difficulty Difficulty with with mobility mobility & & no no aids aids Rehab Rehab potential potential & & no no treatment treatment Falls Falls Social Social isolation isolation with with distress distress Delirium Delirium Negative Negative mood mood Disruptive Disruptive pain pain Inadequate Inadequate pain pain control control Neglect Neglect or or abuse abuse Any Any injuries injuries No No flu flu vaccination vaccination Hospitalization Hospitalization

20 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

21 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.

22 Three building blocks to success. Work processes Success Clinical data systems: interrai HC Software

23 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

24 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)

25 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

26 Talking the same language for effective care of older people For more information visit the interrai websites (International) (Australia)