Using interRAI assessment systems to measure and maintain quality of long-term care
A Good Life in Old Age?
Rapidly ageing populations and increasing prevalence of chronic diseases present major challenges for policy makers. Populations as well as individuals have different prevalence of conditions related to ageing and chronic disease. This is compounded by cultural and institutional differences in care service provision, eligibility criteria and funding models. Comparing differences at population and individual level helps policy makers address the complexities of maintaining quality in long-term
... re. This chapter describes how evolution in development of needs assessment instruments has led to a way of producing high-quality data for policy makers. It describes in detail the interRAI system of standardised needs assessment instruments for routine care that generate aggregatable data. Data driven algorithms generate outcome scales, care planning support protocols, quality indicators, and a resourceuse casemix system. The chapter then illustrates, with data from nine OECD countries and regions, how needs assessment data recorded at the point of care using the interRAI system can inform policy. It ends with a discussion of factors for consideration when implementing sophisticated needs assessment tools. I.3. USING INTERRAI ASSESSMENT SYSTEMS TO MEASURE AND MAINTAIN QUALITY OF LONG-TERM CARE A GOOD LIFE IN OLD AGE? MONITORING AND IMPROVING QUALITY IN LONG-TERM CARE © OECD/EUROPEAN COMMISSION 2013 This chapter describes the background to the formation of the interRAI collaboration, the development, design, distribution, and potential contribution of the interRAI approach to assessment for care and systematic embedding of a quality driven assessment system in care delivery. It also presents data from use of the interRAI system in nine OECD and non-OECD countries and regions, demonstrating the potential for international benchmarking of performance in long-term care. Poor care quality led to a call for more systematic assessments of care needs in the United States In the United States, major scandals in long-term care of older people prompted Congress to ask the US National Academy of Sciences and its Institute of Medicine (IOM) to examine nursing home quality and report on how to improve nursing home regulation. The IOM's expert committee issued its report in 1986 after a 2.5 year study and a series of hearings (Institute of Medicine, 1986; Hawes, 1990) . One of the central recommendations was the development of a uniform, comprehensive resident assessment system. The IOM Committee argued that a uniform, comprehensive assessment of each resident was essential to improving the quality of care in the nation's nursing homes. Comprehensive assessment of physical, cognitive and social functional status was (and still is) seen as the cornerstone of high quality care of older people, identifying issues requiring individualised care planning so that the best outcome of care can be achieved. The IOM recognised that resident-level data from routine assessment of care needs would be the most likely to provide reliable data on quality and outcomes of care. In fact it is not possible to monitor or improve quality of care without being able to measure and compare progress over time or performance between organisations, regions or nations. Many clinical and care services adopt structured approaches to assessment, and the tradition of standardised assessment is strong in many clinical domains. Many disciplines such as neuropsychology, physical, occupational, speech and respiratory therapy have specific assessment tools for structured recording of care need, severity and care outcomes. In care of older people, there is now a long tradition of assessment and there are many publications listing historical best practice (Kane and Kane, 1981; Rubenstein et al., 1995) . As a result of the IOM report, development of the nursing home Minimum Data Set -Resident Assessment Instrument (MDS-RAI) was embedded in a set of reforms enacted by the United States Congress in the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). The original RAI project development consortium was commissioned by the Health Quality Bureau of the US Health Care Finance Administration. The process began by reviewing more than 80 existing assessment instruments incorporating inputs from the designers of those assessments and the long tradition of behavioural and performance assessments and symptom reviews, including that of developmentally disabled individuals. The importance of the review of these kinds of assessments was that they enabled the measures developed within the MDS-RAI, the assessment devices, records of symptoms present and other pieces of information about the resident, to substantially increase the breadth, depth and strength of the assessment system (Morris et al., 1990) . Development was completed in 1990 and the first version of the MDS-RAI was implemented in all US nursing homes in 1990-92.