Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3

Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data

INTRODUCTION

In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack appropriate decision support suitable and sufficient to address the medical and functional complexity of persons with CCCs. This EU-funded project aims to develop decision support systems using high-quality, internationally standardised, routine care data to support better prognostication of health trajectories and treatment impact among older persons with CCCs.

METHODS AND ANALYSIS

Real-world data from older persons aged ≥60 years in home care and nursing homes, based on routinely performed comprehensive geriatric assessments using interRAI systems collected in the past 20 years, will be linked with administrative repositories on mortality and care use. These include potentially up to 51 million care recipients from eight countries: Italy, the Netherlands, Finland, Belgium, Canada, USA, Hong Kong and New Zealand. Prognostic algorithms will be developed and validated to better predict various health outcomes. In addition, the modifying impact of pharmacological and non-pharmacological interventions will be examined. A variety of analytical methods will be used, including techniques from the field of artificial intelligence such as machine learning. Based on the results, decision support tools will be developed and pilot tested among health professionals working in home care and nursing homes.

ETHICS AND DISSEMINATION

The study was approved by authorised medical ethical committees in each of the participating countries, and will comply with both local and EU legislation. Study findings will be shared with relevant stakeholders, including publications in peer-reviewed journals and presentations at national and international meetings.

Collecting Information on Caregivers’ Financial Well-Being: A Document Review of Federal Surveys in Canada

Population-based surveys conducted by governments inform strategies concerning emergent areas of policy interest. One such area is unpaid caregiving in the context of an aging population. In the Canadian and global contexts, research suggests a need for public financial support to mitigate financial risks of caregiving. In this document analysis, we reviewed 17 federal surveys since 2005 to understand how caregiving-related information is captured. We found that caregiving-related questions were largely derived from two surveys, the General Social Survey and the Canadian Community Health Survey. However, gaps exist concerning questions related to estimates of private care expenditure, and the impacts of older adult caregiving across domains of financial risk (income, productivity, and healthcare utilization). Addressing these gaps, either through revising existing surveys or a new national survey on unpaid caregiving, may improve meaningful assessments about risks and impacts of caregiving, which may better inform public strategies that offset these risks.

ArtontheBrain: Results of a Pilot Project Among Long-Term Care Residents

For long-term care (LTC) residents, multiple barriers impede access to formal museum-based participa-tory art programming. Capitalizing on available technologies may circumvent common barriers and improve quality of life for those older adults even in the presence of dementia. Targets: A convenience sample of 31 older adults was recruited from the population of residents in one LTC facility. Intervention: ArtontheBrain, a web-based program, engages participants in activities centered on visual artwork, enabling users to learn about artists through activities, such as puzzles, storytelling, and group discussions. Mechanisms of Action: Researchers hypothesized that engagement with ArtontheBrain would benefit perceived quality of life in the domains of meaningful activity engagement and personal relationships and secondarily, improvements in functional performance, mood state, and cognitive performance may occur. Outcomes: Application of a quality of life survey pre and post ArtontheBrain intervention revealed significant improvements within the individual subsample for two activity options: engagement in enjoyable activities on weekends and evenings and explore new skills and interests. Total scores for the personal relationship scale had significant improvements post-intervention for the individual and group subsamples. The individual subsample demonstrated improvement in cognitive performance, which worsened for the group subsample. Mood and functional ability worsened for the entire sample.[Research in Gerontological Nursing, 14(5), 235-243.].

Cost-effectiveness of a Province-wide Quality Improvement Initiative for Reducing Potentially Inappropriate Use of Antipsychotics in Long-Term Care in British Columbia, Canada

BACKGROUND

Potentially inappropriate use of antipsychotics (PIUA) raises serious concerns about safety, quality, and cost of care for residents in long-term care (LTC).

OBJECTIVE

This study aimed to estimate the cost-effectiveness of the Call for Less Antipsychotics in Long-Term Care (Clear) initiative compared with the status quo (pre-Clear, baseline).

METHODS

A model-based cost-utility analysis, from a public-payer perspective in British Columbia, was conducted using secondary data of residents in LTC homes from 2013 to 2019. Residents' health resource utilization and quality-adjusted life-year (QALY) measures were extracted from multiple administrative databases. Six Markov states were modelled for post-antipsychotic progression representing PIUA, appropriate use of antipsychotic, complete withdrawal, and death. The primary outcome was the incremental cost per QALY gained.

RESULTS

A cohort of 35,669 residents was included in the primary analysis. The Clear initiative, over 10 years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$26,055 (2020 Canadian dollars) per QALY gained at an incremental cost of CA$5211 per resident and a QALY gain of 0.20. In the subgroup analyses, our findings were even more favourable for Clear wave 2 (ICER of CA$24,447 per QALY gained) and Clear wave 3 (ICER of CA$25,933 per QALY gained). At a willingness-to-pay of CA$50,000 per QALY gained, the probabilities of Clear waves 2 and 3 were 82% cost-effective.

CONCLUSION

This study demonstrated incremental costs and yielded favourable ICERs for Clear compared with the baseline. More research is needed to understand the level of support for individual care homes to sustain the Clear initiative in the long run.

Psychometric Properties, Feasibility, and Acceptability of the Self-Reported interRAI Check-Up Assessment

OBJECTIVES

To assess the feasibility, acceptability, and psychometric properties of the self-report version of the interRAI Check-Up (CUSR).

DESIGN

Cross-sectional study of participant ratings of item content and difficulty completing the CUSR. Participants were also randomly assigned to complete the assessment by themselves or with help from a lay interviewer.

SETTINGS AND PARTICIPANTS

A total of 184 older adults from diverse backgrounds, served by 6 Canadian organizations in Ontario and Nova Scotia were recruited. Settings ranged from retirement communities for healthy older adults to assisted living facilities.

MEASURES/METHODS

Time to complete the interRAI CUSR was tracked automatically. Participants self-reported on what items they wanted to have modified, added, or deleted. The also rated whether items were embarrassing or difficult to complete. Psychometric properties were examined between the 2 approaches to completion and were benchmarked against existing reports on psychometric properties of clinician-led home care assessments.

RESULTS

The interRAI CUSR takes about 28 minutes to complete with both self-administered and lay interviewer approaches. The convergent validity and reliability of CUSR is comparable to those of clinician-based assessments like the Resident Assessment Instrument-Home Care. Most participants had no difficulty completing the assessment, and none rated the task as very difficult. Poor self-rated health and difficulty with phone use were predictive of any difficult in completing the assessment in a multivariate logistic regression. Most participants reported that CUSR adequately described their health needs, but arthritis, hypertension, and mental health issues were identified as items to be added by participants.

CONCLUSIONS AND IMPLICATIONS

The CUSR is an appropriate, feasible assessment system with good psychometric properties for use with general populations, including primary care, community services, and patient-reported outcome measurement studies. Interoperability with other interRAI assessments makes it an ideal system to use to obtain a longitudinal view of the person's needs over time.

"Establishing the criterion validity of the interRAI Check-Up Self-Report instrument"

Background

Low and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons.

Methods

We evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights.

Results

Based on Cohen’s Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00.

Conclusion

Our findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa’s.

The primary care and other health system use of home care patients: a retrospective cohort analysis

BACKGROUND

Robust and integrated primary care and home care are core components of effective chronic disease management in the community. We described the primary care and other health system use by a cohort of home care patients.

METHODS

We conducted a population-based retrospective cohort study of patients who received publicly funded home care in Ontario, Canada, from October 2014 to September 2016. Primary outcomes were primary care physician visits including coordination with home care, home visits and visits after hours or on weekends or holidays within 6 months of a home care assessment. Secondary outcomes included specialist physician visits, emergency department use, home care visits and placement in a long-term care home. Multivariable models examined associations between patient characteristics and subsequent primary care use.

RESULTS

There were 226 054 home care patients in our cohort, with a median age of 81 years. Following assessment, home care patients visited primary care physicians at a rate of 0.78 visits per month. Physician-based home care coordination codes were billed for 3.9% of patients. Primary care home visits were received by 13.1% of patients, and 15.1% of patients used primary care after hours or on weekends or holidays.

INTERPRETATION

Patients receiving publicly funded home care frequently visited a primary care physician. Physician billings for coordination between primary care and home care were infrequent but were more common in interprofessional primary care practices. Physician home visits were more likely to be received by the oldest and most functionally impaired patients, suggesting that home visits are responsive to the needs of home care patients.