Autore: John P. Hirdes, Coline van Everdingen, Jason Ferris, Manuel Franco-Martin, Brant E. Fries, Jyrki Heikkilä, Alice Hirdes, Ron Hoffman, Mary L. James, Lynn Martin, Christopher M. Perlman, Terry Rabinowitz, Shannon L. Stewart and Chantal Van Audenhove

 

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.

Sommario

Edited by: Barbara D'Avanzo, Mario Negri Pharmacological Research Institute, Italy
Reviewed by: Giacomo Deste, Civil Hospital of Brescia, Italy Frances Louise Dark, Metro South Addiction and Mental Health Services, Australia
*Correspondence:
John P. Hirdes hirdes@uwaterloo.ca
Specialty section:
This article was submitted to Social Psychiatry and Psychiatric Rehabilitation, a section of the journal Frontiers in Psychiatry
Received: 14 August 2019
Accepted: 21 November 2019
Published: 17 January 2020
Citation: Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL and Van Audenhove C (2020) The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front. Psychiatry 10:926. doi: 10.3389/fpsyt.2019.00926

Autore: Gianlorenzo Scaccabarozzi · Katie Palmer · Graziano Onder · Giacomo Pellegrini · Matteo Crippa · Clara Onorina Colombo · Fabio Lombardi · Giorgio Beretta · Roberto Bernabei, 2019

Aging Clinical and Experimental Research - https://doi.org/10.1007/s40520-019-01427-9

© Springer Nature Switzerland AG 2019 Sommario

Background Dependency in older ages is increasing. Many older persons receive care while living in the community. We aimed to identify the predictive value of four clinical measurements to predict home care intensity in older patients following
discharge from hospital to home care over 90 days.
Methods We included 425 inpatients from the “Frailty Department–Local Palliative Care Network” of the local social health authority (ASST) Lecco, Italy (mean age 75.4 years, SD 14.5; female 75.5%). Changes in Health, End-stage disease, and Signs and Symptoms, light version (CHESS-Lite), activities of daily living (ADL), frailty, and the Service Urgency Algorithm.
Receiver operative curves were used to calculate the area under the curve (AUC) for predicting Home Care Intensity coefficient (ratio of the number of days when any home care was provided 90 days post-discharge). The interRAI Contact Assessment Instrument was used to calculate these measures.
Results Analysis was stratified using six different home care intensity score cut-offs. CHESS-Lite had a higher AUC for predicting home care intensity at all cut-off levels but was best for predicting the highest level of home care intensity (≥ 0.8) where the AUC was 0.71 (0.64–0.79). The frailty index also had an acceptable AUC. ADL had the lowest AUC.
Conclusions Health instability measured with CHESS-Lite has a high predictive value for identifying home care intensity in geriatric patients after discharge from hospital to home, especially in persons with higher home care intensity scores.
Geriatric patients with high health instability should be focused on at discharge to prioritize assessment and initiate timely services for home care support.

Autore: Dawn M. Guthrie, Lisa E. Harman, Lisa Barbera, Fred Burge, Beverley Lawson, Kimberlyn McGrail, Rinku Sutradhar and Hsien Seow, 2019

Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces

JOURNAL OF PALLIATIVE MEDICINE Volume XX, Number XX, 2019 Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2019.0022

Sommario Background: Few measures exist to assess the quality of care received by home care clients, especially at the end of life.

Objective: This project examined the rates across a set of quality indicators (QIs) for seriously ill home care clients.

Design: This was a cross-sectional descriptive analysis of secondary data collected using a standardized assessment tool, the Resident Assessment Instrument for Home Care (RAI-HC).

Setting/Subjects: The sample included RAI-HC data for 66,787 unique clients collected between January 2006 and March 2018 in six provinces. Individuals were defined as being seriously ill if they experienced a high level of health instability, had a prognosis of less than six months, and/or had palliative care as a goal of care.

Measurements: We compared individuals with cancer (n = 21,119) with those without cancer (n = 47,668) on demographic characteristics, health-related outcomes, and on 11 QIs.

Results: Regardless of diagnosis, home care clients experienced high rates (i.e., poor performance) on several QIs, namely the prevalence of falls (cancer = 42.4%; noncancer = 55%), daily pain (cancer = 48.3%; noncancer = 43.2%), and hospital admissions (cancer = 48%; noncancer = 46.6%). The QI rates were significantly lower (i.e., better performance) for the cancer group for three out of the 11 QIs: falls (absolute standardized difference [SD] = 0.25), caregiver distress (SD = 0.28), and delirium (SD = 0.23).

Conclusions: On several potential QIs, seriously ill home care clients experience high rates, pointing to potential areas for quality improvement across Canada.

Keywords: home care; interRAI; quality assessment; quality indicators; RAI-HC

Autore: Lisa E. Harman, Dawn M. Guthrie , Joachim Cohen, Anja Declercq, Kathryn Fisher, Donna Goodridge, John P. Hirdes and Hsien Seow, 2019

Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for Ontario

Harman et al. BMC Palliative Care (2019) 18:3 https://doi.org/10.1186/s12904-018-0389-y Sommario

Background: Currently, there are no formalized measures for the quality of home based palliative care in Ontario.
This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment.

Methods: Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation.

Results: Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%).

Conclusion: Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice.

Keywords: Quality indicators, Quality measures, Palliative care, Seriously ill, InterRAI, End-of-life care, Home care

Autore: Colloca et al. (2012)

Giuseppe Colloca, Matteo Tosato, Davide L. Vetrano, Eva Topinkova, Daniela Fialova, Jacob Gindin, Henriette G van der Roest, Francesco Landi, Rosa Liperoti, Roberto Bernabei, Graziano Onder, for the SHELTER project.

Sommario

Background: It has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven  to  eight  drugs  daily. The  aim  of  this  study  was  to  determine  prevalence  and  factors  associated  with  use  of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.

Methods: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.

Results: Mean age of participating residents was 84.268.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid – ASA –) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21–2.24), heart failure (OR 1.48; 95% CI 1.04–2.09), stroke (OR 1.43; 95% CI 1.06–1.93), and recent hospitalization (OR 1.69; 95% CI 1.20–2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39–0.77).

Conclusion: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

Autore: Onder et al. (2012)

Graziano Onder, Iain Carpenter, Harriet Finne-Soveri, Jacob Gindin, Dinnus Frijters, Jean Claude Henrard, Thorsten Nikolaus, Eva Topinkova, Matteo Tosato, Rosa Liperoti, Francesco Landi, Roberto Bernabei, for the SHELTER project.

Sommario

Background: Aims of the present study are the following: 1. to describe the rationale and methodology of the Services and Health for Elderly in Long TERm care (SHELTER) study, a project funded by the European Union, aimed at implementing the interRAI instrument for Long Term Care Facilities (interRAI LTCF) as a tool to assess and gather uniform information about nursing home (NH) residents across different h alth systems in European countries; 2. to present the results about the test-retest and inter-rater reliability of the interRAI LTCF instrument translated into the languages of participating countries; 3 to illustrate the characteristics of NH residents at study entry.

Methods: A 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items.

Results: Mean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages.

Conclusions: The interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures.