Www.interrai.org Trevor Frise Smith June 2010 “Comprehensive Assessment & Integration of Care...

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

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Agenda• Brief introduction to interRAI and the

interRAI Palliative Care

• Use of the interRAI PC in Ontario

• Care Planning – caregiver distress

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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

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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

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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.

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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

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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


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)

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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

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Caregiving Patterns and Caregiver Distress Among Community Palliative Care

Clients


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Sex and Marital Status of Palliative Home Care Clients, Ontario, 2006-2008


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Percentage of Palliative Home Care Clients Diagnosed with Cancer, Ontario, 2006-2008


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Top 10 Cancer Diagnoses (4a) and Non-Cancer Diagnoses (4b) of Palliative Home Care Clients, Ontario, 2006-2008


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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.


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Palliative Home Care - Ontario


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Estimated Prognosis2, Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Unstable Health2, Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Level of Physical and Cognitive Performance2,3 ,Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Count of Gastro-Intestinal Problems2 and Count of Nutritional Issues3,

Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Status of Dyspnea and Adequacy of Pain Control,

Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Indicators of Potential Depression, Ontario, 2006-2008


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Percentage of Palliative Home Care Clients with Distressed Caregivers1 by Hours of Informal Care Received over last 3 days, Ontario, 2006-

2008


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Percentage of Palliative Home Care Client's with Distressed Caregivers1 by Palliative Home Care Client's Perspectives on Life, Ontario, 2006-2008


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Self-reported sadness, depression by “wish to die now”


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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


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www.interrai.org

Thank You!

Questions or Comments?


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Www.interrai.org Trevor Frise Smith June 2010 “Comprehensive Assessment & Integration of Care...

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