Healthcare Management Forum最新文献

Older adults living with frailty and multimorbidity interact with multiple care providers and health settings, resulting in fragmented care and information discontinuity. Standardized assessments potentiate integrated care by communicating consistent measures of health information between sectors and providers. We use a pragmatic case example of a theoretical medically complex older adult to illustrate use of interRAI standardized assessments throughout the health journey. The case example represents the assessment findings of a patient accessing care through primary care, the emergency department, home/community care and long-term care. A suite of assessment instruments embedded with decision support algorithms guides nursing care decisions, while a common language and standardized assessment items support effective communication and collaboration among the health team. Successful adoption of integrated and comprehensive assessment tools requires training, engagement, and time to embed processes into practice. interRAI assessments enable integration through a common language, aligning successive assessments across the care continuum.

Fragmented healthcare systems worldwide struggle to support patient populations with complex health and social needs. System integration requires a standardized clinical health information system to better care for these populations. This review describes how interRAI systems evolved into powerful solutions to support healthcare system integration. In response to a care quality crisis in long-term care homes in the United States, Congress mandated a standardized Minimum Data Set (MDS) from which multiple outputs were derived to support care planning, care quality, and case-mix assessment. This work drew international attention, leading to the creation of interRAI. Three decades of extensive international research, stakeholder engagement, and implementation have led to the creation of comprehensive cross-sectoral assessment systems for diverse populations, including older adults, mental health patients, and children and youth. The interRAI assessment systems, widely used in Canada and internationally, constitute comprehensive clinical assessment systems capable of supporting health system integration.

There are rich data available from assessments like the interRAI Mental Health that may not be shared with patients in usable ways. We outline a co-design process as an example for health system providers interested in developing platforms for sharing interRAI information with care recipients. Persons with lived experience (current and past service users) identified design specifications for summaries of interRAI data over a series of co-design workshops, including visual and text representations of clinical information as well as processes for sharing summaries with patients. Graphic and text considerations were identified in workshops, including icons associated with key clinical issues and nuanced text summaries of assessment outputs and implications. Participants noted that persons in inpatient care should review this information once stable, and with assistance of a peer support specialist. This work affirms that it is not only desirable, but entirely achievable from an organizational perspective to prioritize and integrate patient voices in the design and use of clinical information.

An interRAI assessment is required for older people in Aotearoa New Zealand (NZ) to access public aged care services. Paeārahi (Māori health navigators) provide culturally-appropriate, connected healthcare. We investigated the feasibility and acceptability of paeārahi-facilitated Check Up Self Report (CU-SR) completion with older Māori in NZ. Prospective non-randomised, non-comparator intervention study in one NZ health practice with eligible participants (Māori, 55 years or older, community-dwelling, not known to require formal needs assessment). Predefined feasibility and acceptability outcomes were reported using descriptive statistics and thematic analysis. Participants (n = 50, mean 65.3 years, 66% female) felt most CU-SR items were acceptable. Paeārahi-facilitated assessment and care planning were generally acceptable and feasible to undertake and perceived to improve healthcare access. Paeārahi-facilitated CU-SR assessment and care planning is a scalable model utilising a culturally appropriate, non-regulated Indigenous health workforce and an internationally validated assessment with the potential to identify unmet need and address inequities in aged care access.

interRAI instruments consist of clinical information systems able to support integrated care. Through a scoping review, we describe how interRAI instruments are used: (1) as interventions (implementation category) and (2) to evaluate interventions (efficacy category) in older adults. In accordance with the PRISMA-ScR framework, we searched 6 databases and conducted dual-independent screening, with conflicts resolved by a third reviewer. Data extraction followed an identical procedure. The review yielded 64 manuscripts, including 43 and 21 categorized as studies of efficacy or implementation, respectively. Findings indicate that interRAI systems are consistently utilized to evaluate or enhance participant-centred outcomes across diverse healthcare settings in 17 countries, with a particular emphasis on home and long-term care. interRAI is a versatile system with the potential to form the foundation of an integrated clinical information system. This review provides a basis for future research testing novel intervention strategies with interRAI systems.

The objective of this article is to examine the interRAI system for developing digital solutions. As an organization, interRAI provides all the necessary tools for digitalization of interRAI assessments and applications to create an integrated information system for decision support. The organization's model for developing software is to license software vendors in a competitive market. Thus, service providers should carefully consider required and desired features and functionality of software as these will determine how well the interRAI system will work in daily practices. The eight features presented in this article offer general guidelines for procurement agencies and software developers.

This article reports on the fourth interRAI Summer Program of International Research (inSPIRe), an intensive capacity-building initiative with a structured program, hosted at McMaster University in July 2024. Twenty-four delegates from 14 countries attended, representing diverse backgrounds in research, clinical practice, policy, and health informatics. The inSPIRe initiative aimed to foster understanding of interRAI's assessment systems, develop methodological skills, establish mentorship relationships, create opportunities for contribution to the interRAI consortium, and initiate global collaborations. All participants reported that the program met or exceeded their expectations, with significant benefits including access to comprehensive international datasets, engagement with experienced mentors, and effective knowledge translation between research and practice. Regional adaptations of the program have already emerged, demonstrating its scalability and impact beyond the initial intensive experience. The inSPIRe program represents an effective and flexible model for building global health services leadership and research capacity and capability, applicable internationally.

Equitable and effective service and policy decisions require reliable evidence-based information; interRAI assessments offer objective data across broad health determinants for multiple purposes. This article aims to highlight selected embedded scales and algorithms and illustrate their prevalence across settings using Canadian data. Ten measures are described along with examples of subsequent use in predicting outcomes, adverse events, and resource utilization across diverse populations and jurisdictions. Prevalence rates for nine scales and algorithms were available across home and community care, Long Term Care (LTC), and inpatient settings. Higher rates of disability in function and cognition were seen in LTC and CCC, whereas palliative care has highest prevalence of health instability. Overlaps in key areas suggest the need to provide targeted services irrespective of setting. Overall, this article highlights the potential of scales and algorithms to capture key clinical information across the broader health determinants while minimizing assessment burden.

The implementation of interRAI systems is often influenced by factors including healthcare priorities, policy and service requirements, fragmentation of care systems, and existing data standards. Utilizing a rapid review methodology, PubMed was searched for publications, and senior fellows in countries that implemented or piloted interRAI systems shared reports with a total of 40 papers retained and reviewed. Strengths, barriers, and recommendations were extracted. Comprehensive standardized instruments, solid psychometric properties, and the multiple uses of assessment information were noted as strengths. The most frequently cited barrier was lack of infrastructure, related to technological infrastructure and education/training. This review offers lessons to facilitate successful implementation of interRAI systems. Resource allocation to support hiring of staff, education/training, and the purchasing of information and technology solutions; and technology infrastructure to reduce the burden of assessment and support the continuity of care across care settings were among the top recommendations provided in this review.