Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI‐HC

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Abstract

Aim

Home care nurses often use the Resident Assessment Instrument‐Home Care (interRAI‐HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI‐HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile).

Design

Data were collected at the baseline assessment of the fraXity study ( N = 231, aged ≥ 65), which relied on an observational longitudinal design.

Methods

Measures were the interRAI‐HC, from which the CI binary variables were computed and the COMID, used as a reference.

Results

Twenty‐six CI variables were computed from the interRAI‐HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 ( p < .001).

Conclusions

The study demonstrates that complexity can be assessed directly from the interRAI‐HC by deriving a CI.

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Most cited references 31

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A standard procedure for creating a frailty index

Samuel Searle, Arnold Mitnitski, Evelyne A Gahbauer … (2008)

Background Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index. Methods This is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment. Results Procedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0–1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014–0.026) to 0.026 (0.020–0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality. Conclusion A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.

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The clinical application of the biopsychosocial model.

G Engel (1980)

How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. A medical rather than psychiatric patient was selected to emphasize the unity of medicine and to help define the place of psychiatrists in the education of physicians of the future.

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Defining comorbidity: implications for understanding health and health services.

J. M. Valderas, B Starfield, B. Sibbald … (2009)

Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.

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Author and article information

Contributors

Catherine Busnel:

ORCID: https://orcid.org/0000-0002-0165-022X

catherine.busnel@imad-ge.ch

Journal

Journal ID (nlm-ta): Nurs Open

Journal ID (iso-abbrev): Nurs Open

Journal ID (doi): 10.1002/(ISSN)2054-1058

Journal ID (publisher-id): NOP2

Title: Nursing Open

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2054-1058

Publication date (Electronic): 25 November 2020

Publication date Collection: March 2021

Volume: 8

Issue: 2 ( doiID: 10.1002/nop2.v8.2 )

Pages: 815-823

Affiliations

[ ¹ ] Research and Development Unit Geneva Institution for Homecare and Assistance (imad) Carouge Switzerland

[ ² ] Geneva School of Health Sciences, HES‐SO University of Applied Sciences and Arts Western Switzerland Geneva Switzerland

Author notes

[*] [* ] Correspondence

Catherine Busnel, Research and Development Unit, Geneva Institution for Homecare and Assistance (imad), Avenue Cardinal Mermillod 36, 1227 Carouge, Switzerland.

Email: catherine.busnel@ 123456imad-ge.ch

Author information

Catherine Busnel https://orcid.org/0000-0002-0165-022X

Catherine Ludwig https://orcid.org/0000-0003-4634-2092

Article

Publisher ID: NOP2686

DOI: 10.1002/nop2.686

PMC ID: 7877136

PubMed ID: 33570265

SO-VID: 1508847e-8bed-4bd0-b5fd-79cef5cd5fac

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 09 August 2020

Date revision received : 05 October 2020

Date accepted : 27 October 2020

Page count

Figures: 0, Tables: 2, Pages: 9, Words: 6990

Funding

Funded by: Swiss National Science Foundation , open-funder-registry 10.13039/501100001711;

Award ID: 10001C_179453/1

Custom metadata

source-schema-version-number 2.0

cover-date March 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.7 mode:remove_FC converted:11.02.2021

Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI‐HC

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Chinese Journal of General Practice

Most cited references 31

A standard procedure for creating a frailty index

The clinical application of the biopsychosocial model.

Defining comorbidity: implications for understanding health and health services.

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