www.interrai.org

All about interRAI…

Len Gray

Coordinator, interRAI Network of Excellence in Acute Care

April 2014

www.interrai.org

The interRAI research collaborative

30+ nations

80+ clinicians &

scientists

Australia

Belgium

Canada

Chile

China

Czech Republic

Denmark

Estonia

Finland

France

Germany

Hong Kong

Iceland

India

Israel

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

• CAM

• AMT

• Hamilton DRS

• MNA

• Waterlow

• Katz ADL

• FRAT

• Various fillers to meet nursing requirements

The Result

• Inconsistent scoring

methods

• Item duplication

• Training challenges

• IT unfriendly

• Significant documentation

burden

• Poor compliance

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

Clinical

observations

Outcome

measurement

scales

Quality

indicators

Case mix

Indications for

clinical

intervention

Diagnostic &

risk screening

Clinical

summaries

www.interrai.org

The interRAI Acute Care

Diagnostic

screeners

Delirium

Dementia

Depression

Malnutrition

Risk assessment

Delirium

Pressure ulcer

Falls

Functional decline

Institutional care

Readmission

Severity measures

Delirium

Cognition

Communication

Mood

ADL

IADL

Pain

Nutrition Recommendations

(CAPs)

ADL

Cognition

Communication

Delirium

Depression

Pain

Pressure ulcer

Institutional risk

Readmission

Medications

Quality indicators

Self care, mobility,

IDC, falls, pressure

ulcer, institutional

placement

Clin

ica

l

observ

ations

www.interrai.org

The Hospital Journey

ED Acute Care Post - Acute Care Post - Acute Community

Care

CAM AMT

CAM MMSE Waterlow FRAT MNA

FIM MMSE GDS

Barthel MMSE

Result: Inconsistent data format; high documentation burden; poor compliance; no data sharing

www.interrai.org

The interRAI

Hospital Mini-Suite

interRAI ED interRAI AC interRAI PAC interRAI HC Assessment tools

Emergency Department

Acute Ward Post Acute Ward Post Acute Community

Standalone Screener

Need for CGA

Derivative measures

Severity measures Multi-setting

General: Function, Frailty Specific : Cognition, Communication, ADL, IADL, Pain, Nutrition

Quality indicators Setting specific

Outcome QIs

Delirium, Dementia, Malnutrition, Depression Diagnostic screeners Setting specific

Risk screeners Setting specific

Delirium, Falls, Pressure Ulcer

Clinical Assess’t Protocols Setting specific

Acute Care CAPs Home Care CAPs Post-acute Care

CAPs

www.interrai.org 13

interRAI AC 2009

interRAI HC 2005

interRAI ED Screener 2014

Ward Admission Assessment

SPECIALIST GERIATRIC ASSESSMENT

GENERAL ASSESSMENT

interRAI AC-PAC 2015

interRAI ED CA 2014

General ward geriatric care

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