Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.

Beyond the 'iron lungs of gerontology': using evidence to shape the future of nursing homes in Canada.

The Value of Qualitative Description in Health Services and Policy Research.

The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer’s disease and other dementias, Parkinson’s disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 – 1.00) and comparative chronic diseases (range 0.83 – 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.

/pdf/diagnostic-data-for-neurological-conditions-in-interrai-1meoq9uoff.pdf

Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study

The aim of this project is to describe the quality of assessment data regularly collected in home and community, with techniques adapted from an evaluation of the quality of long-term care data in Canada. Data collected using the Resident Assessment Instrument – Home Care (RAI-HC) in Ontario and British Columbia (BC) as well as the interRAI Community Health Assessment (CHA) in Ontario were analyzed using descriptive statistics, Pearson’s r correlation, and Cronbach’s alpha in order to assess trends in population characteristics, convergent validity, and scale reliability. Results indicate that RAI-HC data from Ontario and BC behave in a consistent manner, with stable trends in internal consistency providing evidence of good reliability (alpha values range from 0.72-0.94, depending on the scale and province). The associations between various scales, such as those reflecting functional status and cognition, were found to be as expected and stable over time within each setting (r values range from 0.42-0.45 in Ontario and 0.41-0.43 in BC). These trends in convergent validity demonstrate that constructs in the data behave as they should, providing evidence of good data quality. In most cases, CHA data quality matches that of RAI-HC data quality and shows evidence of good validity and reliability. The findings are comparable to the findings observed in the evaluation of data from the long-term care sector. Despite an increasingly complex client population in the home and community care sectors, the results from this work indicate that data collected using the RAI-HC and the CHA are of an overall quality that may be trusted when used to inform decision-making at the organizational- or policy-level. High quality data and information are vital when used to inform steps taken to improve quality of care and enhance quality of life. This work also provides evidence that a method used to evaluate the quality of data obtained in the long-term care setting may be used to evaluate the quality of data obtained through community-based measures.

/pdf/evaluation-of-data-quality-of-interrai-assessments-in-home-2vj5pzdt0h.pdf

Evaluation of data quality of interRAI assessments in home and community care.

The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: a questionnaire study.

Background:The case-mix system Resource Utilization Groups version III for Home Care (RUG-III/HC) was derived using a modest data sample from Michigan, but to date no comprehensive large scale validation has been done.Objectives:This work examines the performance of the RUG-III/HC classification usi

Validation of Resource Utilization Groups version III for Home Care (RUG-III/HC): evidence from a Canadian home care jurisdiction.

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Validation of Resource Utilization Groups version III for Home Care (RUG-III/HC): evidence from a Canadian home care jurisdiction.