Post on 22-Dec-2015
www.interrai.orgTrevor Frise Smith June 2010
“Comprehensive Assessment & Integration of Care Planning using the interRAI Palliative Care: findings from Ontario community-based care.”
Trevor Frise Smith, PhD.1,2
Karen Lacelle 3
1Associate Professor, Nipissing University, Ontario, Canada2 Fellow, interRAI.3 Educator, West
North East Community Care Access Centre
Northern Ontario Medical School – Research Conference Laurentian University , Sudbury, Ontario
June 04, 2010
1
www.interrai.orgTrevor Frise Smith June 2010
Agenda• Brief introduction to interRAI and the
interRAI Palliative Care
• Use of the interRAI PC in Ontario
• Care Planning – caregiver distress
2
www.interrai.org
“Now that you mention it doctor …. symptom reporting and the need for systematic questioning in a specialist
palliative care unit”• Study by White, McMullan
& Doyle, J of Pall Med (12) 2009.
• Compared symptom self-report with systematic questioning.
• 2/3 of symptoms experienced by patient were not
self-report.
Trevor Frise Smith June 2010
3
www.interrai.orgTrevor Frise Smith June 2010
interRAI• Non-profit organization• International group of clinicians & researchers
• Develop standardized assessment instruments for (mainly) non-acute care
• Use as “admission or intake” assessment.• Focus upon client functioning, needs, resources.
• Not diagnosis• Meets twice a year
• Science (e.g., cross-national comparisons)• Instrument development• Support implementation in other nations
• Holds copyright to RAI assessment instruments• Grants royalty-free licenses to governments and care providers• www.interrai.org
4
www.interrai.orgTrevor Frise Smith June 2010
interRAI develops “clinical support” tools
• Not automated, computerized care planning• Rather, client-level information, can be
computerized, then used to assist care planning
• Not diagnostic tools
• Not automatic decision tools • Rather - help with decision making, assist care
planning.
5
www.interrai.orgTrevor Frise Smith June 2010
Criteria for Adding Items on Assessment Form
• Care planning “trigger”• Outcomes assessment• Quality indicator• Case-mix grouper
• In addition:• Fewest number of items for “trigger”• All items, research / clinical based• Ongoing validity & reliability assessment
6
www.interrai.org
Provincial Implementation of interRAI Instruments in Ontario
Instrument Setting Date of Implementation
Population Number of assessments
RAI-Home Care (RAI-HC)
•CCAC(Community)•CCAC(Hospital)
•2003
•2004
•Long Stay
•Pts awaiting LTC
•1,100,000
•60,000
Contact Assessment (CA)
•CCAC (Intakes)
•Initial implementation in 2006
•Hosp inpt•Hosp outpt•Community
•24,000•10,000•28,000
RAI-Mental Health (RAI-MH)
•Inpatient Psychiatry
•2005 •All pts •350,000
RAI 2.0 •CCC•LTC
•1996•Underway since 2005
•All pts•All residents
•356,000•73,000
Hirdes May 2010
www.interrai.orgTrevor Frise Smith June 2010
In Ontario - - CCAC sites in 6 (red) ofthe 14 Local Health Integration Networks (LHINs) have (will have) adopted the interRAI PC.
• LHIN-1 (Erie St. Clair)• LHIN-2 (South West)• LHIN-3 (Waterloo Wellington)• LHIN-4 (Hamilton Niagara Haldi-
Brant)• LHIN-5 (Central West)• LHIN-6 (Mississauga Halton)• LHIN-7 (Toronto Central)• LHIN-8 (Central)• LHIN-9 (Central East)• LHIN-10 (South East)• LHIN-11 (Champlain)• LHIN-12 (North Simcoe Muskoka)• LHIN-13 (North East)• LHIN-14 (North West)
8
www.interrai.orgTrevor Frise Smith June 2010
interRAI PC Domainsversion 2006 (9)
• Identification &
Intake/initial hx
• Health conditions
• Oral/nutritional status
• Skin conditions
• Cognition
• Communication
• Mood & Behaviour
• Psychosocial well-being
• Physical functioning• Continence• Medications• Treatments & procedures• Responsibilities /
directives• Social supports• Discharge info• Assessor info
9
www.interrai.org
Caregiving Patterns and Caregiver Distress Among Community Palliative Care
Clients
Trevor Frise Smith June 2010
12
www.interrai.org
Sex and Marital Status of Palliative Home Care Clients, Ontario, 2006-2008
Trevor Frise Smith June 2010
13
www.interrai.org
Percentage of Palliative Home Care Clients Diagnosed with Cancer, Ontario, 2006-2008
Trevor Frise Smith June 2010
14
www.interrai.org
Top 10 Cancer Diagnoses (4a) and Non-Cancer Diagnoses (4b) of Palliative Home Care Clients, Ontario, 2006-2008
Trevor Frise Smith June 2010
15
www.interrai.org
Indicators of Caregiver Distress1 among Informal Caregivers of Palliative Home Care Clients, Ontario, 2006-2008
1 Indicators of caregiver distress include: helper(s) unable to continue caring activities; primary informal helper expresses feelings of distress, anger, or depression; family or close friends report feeling overwhelmed by person's illness.
Trevor Frise Smith June 2010
16
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Estimated Prognosis2, Ontario, 2006-2008
Trevor Frise Smith June 2010
18
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Unstable Health2, Ontario, 2006-2008
Trevor Frise Smith June 2010
19
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Level of Physical and Cognitive Performance2,3 ,Ontario, 2006-2008
Trevor Frise Smith June 2010
20
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Count of Gastro-Intestinal Problems2 and Count of Nutritional Issues3,
Ontario, 2006-2008
Trevor Frise Smith June 2010
21
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Status of Dyspnea and Adequacy of Pain Control,
Ontario, 2006-2008
Trevor Frise Smith June 2010
22
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Indicators of Potential Depression, Ontario, 2006-2008
Trevor Frise Smith June 2010
23
www.interrai.org
Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Hours of Informal Care Received over last 3 days, Ontario, 2006-
2008
Trevor Frise Smith June 2010
24
www.interrai.org
Percentage of Palliative Home Care Client's with Distressed Caregivers1 by Palliative Home Care Client's Perspectives on Life, Ontario, 2006-2008
Trevor Frise Smith June 2010
25
www.interrai.org
Self-reported sadness, depression by “wish to die now”
Trevor Frise Smith June 2010
26
www.interrai.org
Implications for Policy and Practice• interRAI PC may be used to identify clients and caregivers
at risk of adverse outcomes and distress
• Seven CCACs have begun to use PC, and OACCAC plans to expand to province wide implementation
• Many predictors of caregiver distress may be manageable through good quality care to the palliative client
• Palliative care appears to be a restricted service that reaches mainly cancer patients• Need to consider equity of access for persons dying
due to other causes
Trevor Frise Smith June 2010
27