the same language
This first newsletter for 2011 brings exciting news of major implementations of interRAI instruments across the region – in Australia, New Zealand and Singapore. Our New Zealand colleagues report a novel use of interRAI assessments in the response to the recent Christchurch earthquake. Research programs remain active with our region making important contributions to the development of interRAI systems.
>> interRAI Suite demonstration in Singapore
Brigette Meehan reports...
We took Canterbury District Health Board (CDHB) data of older people living in the community who had a home care assessment in the last 14 months; and from this we created a list of 'vulnerable' elderly people;
The idea to create the list came from our international interRAI colleagues and Dr Nigel Millar (NZ interRAI Fellow and Chief Medical Officer) at CDHB. We were able to use our newly created interRAI national datawarehouse and got expert analysis help from another DHB (Capital & Coast DHB). The Incident Controller for Vulnerable People at Christchurch reported that the list has proven to be of great help in the last week.
Since 2008, we have been active in publishing books to support interRAI’s new Suite of assessment systems. These books can be purchased online at catalog.interrai.org, which also provides volume discounts.
Fourteen interRAI publications are now available to the global market, constituting most of the Standard Editions of our instrument suite. AC/PAC and ESP are slated for 2011; ID, AL, CF, QOL, and WELL are under discussion. The Standard Editions are international in scope; all are in English, and contain country-specific information in [square brackets], making them readily adaptable to individual markets.
Several countries have localized the manuals so far. The Canadian Institute for Health Information (CIHI) plans to bring out editions of all the Suite instruments it supports, currently only the CHA, which was published in 2010. In the works are also localized instruments for Singapore and Australia (HC, LTCF).There are also successful options to publish translations, utilized in developing language versions of manuals in Dutch, Estonian, Italian, and Spanish.
To reach best the global market and to reduce interRAI’s investment in printing, binding, and inventory, we selected Lightning Source as our Print on Demand (POD) vendor, with plants in the USA and UK. Additionally, to enhance speed to market and reduce shipping and customs costs for end users, we have contracted with printers in countries where there promises to be a larger market, such as Australia, Canada, and Singapore.
This month (February 2011), interRAI will launch its e-publishing program. Books will be available for download on a per-copy basis; their list price will be the same as paper, and they will be discounted the same as paper books. The site will allow visitors to browse inside publications, a technology that could be copied to other interRAI websites. Books purchased through the website will be protected so that they can only be used on the computer they were downloaded to, and not printed.
Through the end of 2010, we have sold 1144 units (books and forms), with the vast majority of those sales coming in the last 6 months. We began at the end of 2010 making marketing copies available to interRAI Fellows at 60% discount off list price – these are for marketing and demonstration purposes only, not for clinical application.
Overall, we have made good progress in attaining the original Portal goal of building an infrastructure to gain control of our intellectual property, to help interRAI become a global standard. With most of the Standard Editions either published or in the queue for production, we now are focusing on localizations and translations. We expect 2011 to be the year when we firm up our technology infrastructure and better define our internal publishing workflow procedures to successfully manage our organization’s primary asset, our collectively developed intellectual property.
Editor note: The suite is currently in use in Australia. The interRAI AC manual is available for purchase. In 2011, Australian versions of the HC and LTCF will become available.
The Singapore Government recently secured licences for a range of interRAI suite instruments, in preparation for a multi-domain implementation. The initial focus will be on improving assessment, care planning and eligibility systems for older people receiving institutional and home care services. Initial pilots will use the interRAI LTCF and HC. Singapore versions of these instruments, including manuals, have been prepared.
Singapore has a population of about 5.1 million people of whom around 6.7% are aged over 65 years. It is one of the world’s most densely populated nations. Population ageing – like many other nations – is receiving considerable attention among policy-makers.
This is a well planned and carefully organised development, which ultimately aims to take advantage of all of the features that the interRAI suite has to offer. A train the trainer program is in progress, and a large number of assessors have already been trained. The effort is supported by interRAI Australia. A Singapore delegate will attend the next interRAI Fellows’ meeting in Nuremburg.
Currently District Health Boards are involved in a national project to use the Home Care and Contact assessments. Recently a Project Manager position has been advertised to lead a project extending the use of interRAI instruments into residential care. The project, which will use the assessment from the new integrated suite the Long Term Care Facility assessment (iLTCF), is anticipated to get underway immediately.
Australia’s largest private provider of long term care places will shortly commence implementation of the interRAI LTCF. The Domain Principal Group operates over 5000 places in 60 facilities across Australia. This implementation is initially designed to improve the standard of assessment across the organisation, and later to exploit the LTCF Quality Indicator set as a major quality of care improvement strategy.
This will constitute Australia’s largest interRAI implementation to date. DPG is working closely with the Centre for Research in Geriatric Medicine in Brisbane on an evaluation strategy for this very significant intervention.
A paper written by PhD candidate Nathalie Wellens, from Belgium, has recently been published in the Journal of Evaluation in Clinical Practice. This provides an extremely comprehensive framework around instrument development and testing, which, although centred on the interRAI AC, has relevance to all assessment systems. Recommended reading! Citation is listed below.
In order to promote and encourage development of specific instrument groups, interRAI is establishing “Networks of Excellence” in special areas. The interRAI Network of Excellence in Mental Health was established several years ago, and has pushed forward development of the mental health assessment systems, as well as supporting multi-national research in mental health.
interRAI will now establish the interRAI Network of Excellence in Acute Care (for older persons) to concentrated attention on instrument development and research in and around hospital care. The work will encompass the ED screener, the interRAI AC, the interRAI Post-Acute Care and assessment in the community after discharge from hospitals. This Network will be led by Prof Len Gray. The inaugural meeting of some 30 delegates will be held in Nuremberg, Germany in May 2011.
interRAI ED study approaches completion
A multi-national observational study being conducted by the ED Study Group is nearing completion. Over 2000 assessments were completed across 7 countries, including over 250 from Australia. Results will be published later in 2011.
interRAI AC QI study well advanced
An Australian study designed to create and test QIs applicable to the care of older patients in acute care is approaching completion. The QIs were developed by an expert panel, in consultation with the interRAI ISD, and were subsequently field tested in 9 Australian hospitals. The final QIs will be determined after review of the field study. The QIs should be available for consideration within interRAI by mid 2011.
The study also collected ACOVE III process indicators, which will provide an interesting comparison with the “outcome” indicators derived from the interRAI AC.
The study is being conducted by Len Gray and Melinda Martin-Khan at the Centre for Research in Geriatric Medicine in Brisbane. The Centre also recently secured funding to conduct a similar study in emergency departments.
No new instruments have been “released” since our last newsletter.
However, at its most recent meeting in December, the ISD was undertaking important work in several areas, including:
Review and standardisation of all scales. It is hoped that a “Scale Manual” will be prepared in the next 12 months. Refinement of the CPS to improve its sensitivity in the low and mid range.
A self-reported quality of life instrument will be considered for approval at the April meeting.
Wellens, N. I. H., Milisen, K., Flamaing, J. and Moons, P. , Methods to assess the validity of the interRAI Acute Care: a framework to guide clinimetric testing. Journal of Evaluation in Clinical Practice, (eprint ahead of publication) doi: 10.1111/j.1365-2753.2010.01571.x