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      Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments

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          Abstract

          Background:

          The improvement of quality of care requires a standardized and comprehensive assessment tool but implementation is challenging.

          Purpose:

          We have reported on the development of the interRAI instruments in France from the onset to the mandatory use at the national level. We also have identified in the literature and in practices, incentives and barriers for the implementation of this integrated clinical information system in long term care.

          Results:

          Three periods in the interRAI instruments development were identified over the last twenty years. The first one was a research approach about improving quality of long term care. The second one was an experimental clinical use into an integrated care model with case management. The third one was a call for tenders issued by a French national agency, and the choice to use the interRAI-HC (Home Care) for all case managers. The main incentives and barriers that were identified include the national context, the target population, the providers involved and the impact on their practice, the interRAI instrument characteristics, training and leadership.

          Conclusion:

          This historical overview of the development of interRAI instruments in France gives health care organizations pertinent information to guide the implementation of a standardized and comprehensive assessment tool.

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          Most cited references41

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          Comprehensive clinical assessment in community setting: applicability of the MDS-HC.

          To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS-HC), including reliability estimates, a comparison of MDS-HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS-HC. Independent, dual assessment of clients of home-care agencies by trained clinicians using a draft of the MDS-HC, with additional descriptive data regarding problem profiles for home care clients. Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS-HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States. The array of MDS-HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications. Forty-seven percent of the functional, health status, social environment, and service items in the MDS-HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS-HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS-HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels. Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community-based, second-generation problem and care plan-driven assessment instrument, disability assessment can be performed consistently across the world.
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            Designing the national resident assessment instrument for nursing homes.

            In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.
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              Randomised trial of impact of model of integrated care and case management for older people living in the community.

              To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Randomised study with 1 year follow up. Town in northern Italy (Rovereto). 200 older people already receiving conventional community care services. Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. Admission to an institution, use and costs of health services, variations in functional status. Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of 1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.
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                Author and article information

                Contributors
                Journal
                Int J Integr Care
                Int J Integr Care
                1568-4156
                International Journal of Integrated Care
                Ubiquity Press
                1568-4156
                18 April 2018
                Apr-Jun 2018
                : 18
                : 2
                : 5
                Affiliations
                [1 ]Assistance Publique Hôpitaux de Paris, Hospitalisation à Domicile, Unité Mixte de Recherche (UMR) 1168 INSERM, UVSQ, VIMA (Vieillissement et Maladies Chroniques), InterRAI France, Paris, FR
                [2 ]Institut Maladie Alzheimer (IMA), Centre Départemental de Gérontologie, interRAI France, Marseille, FR
                [3 ]Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, Unité Mixte de Recherche (UMR) 1168 INSERM, UVSQ, VIMA (Vieillissement et Maladies Chroniques), InterRAI France, Paris, FR
                [4 ]Centre Départemental de Gérontologie, InterRAI France, Marseille, FR
                [5 ]Université de Versailles, Saint-Quentin en Yvelines, InterRAI France, Paris, FR
                Article
                10.5334/ijic.3297
                6095084
                0d3005d7-adee-484a-bfa4-2acd11268c33
                Copyright: © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 August 2017
                : 26 March 2018
                Categories
                Research and Theory

                Health & Social care
                standardized comprehensive assessment,integrated model of care,interrai instruments,long term care

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