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The Development of BelRAI, a Web Application for Sharing Assessment Data on Frail Older People in Home Care, Nursing Homes and Hospitals

  • June 2014
DOI:10.4018/978-1-4666-6138-7.ch010
  • In book: Achieving Effective Integrated E-Care Beyond the Silos
  • Chapter: 10
  • Publisher: IGI Global (Disseminator of Knowledge Since 1988) International Publisher of Progressive Academic Research
  • Editors: Ingo Meyer, Sonja Müller, Lutz Kubitschke
Authors:
Dirk Vanneste at KU Leuven - University of Leuven - Belgium
Dirk Vanneste
  • KU Leuven - University of Leuven - Belgium
Anja Declercq at KU Leuven
Anja Declercq
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Abstract

As the complexity of caregiving rises and surpasses traditional models of care, the need for comprehensive and integrated assessment systems increases. The use of standardized and computerized data—available to those who must make decisions—has become paramount. In Belgium, the BelRAI web application has been developed to support the use of interRAI assessment instruments in a multidisciplinary way and to exchange client-centered information across care settings. This chapter describes the particularities of BelRAI, the security aspects, the support tools, the gradual process of implementation, the do’s and don’ts, the pro’s and con’s and the challenges for the future. The benefits seem to overrule the drawbacks but it has also become clear that only a significant expenditure on resources with regard to adequate staffing in healthcare environments, appropriate information technology, and training facilities can contribute to a successful introduction, maintenance and full exploitation of this innovative health information system.
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DOI: 10.4018/978-1-4666-6138-7.ch010
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... Some examples are the interRAI scales, validated with gold standard scales, and the CAPs (Clinical Assessment Protocols or Collaborative Action Points), which are trigger algorithms to alert caregivers of specific problem situations and provide guidelines for care planning. [8,9]. The scales and trigger algorithms are automatically generated in the electronic application when the interRAI assessment is filled out. ...
... The applications enable the transfer of client data between health care settings and therefore ensure continuity of care and facilitate multidisciplinary collaboration. Another feature of the applications is that professional caregivers can observe the evolution of their clients' outcomes (CAPs, scales and RUG groups) individually or in groups by using statistical software imbedded in the tool [9]. ...
... In addition, it is not always clear to professionals how to use evidence-based outcomes to create care plans in a multidisciplinary way or how to use these outcomes to match services to clients. The interRAI outcomes make it possible to create care plans effectively and to prepare the multidisciplinary meetings, so that each caregiver, together with the client and the care provider, can decide which are the important problems and needs to address [9]. Collaboration involving all stakeholders can therefore happen in a structured way supported by the assessment and the IT platform. ...
The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System
Article
Full-text available
Introduction: In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand. Methods: The study applied a case study methodology with the focus on the implementation strategies in each country. Principal investigators gathered relevant information from multiple sources and summarised it according to specific aspects of the implementation process, comparing them across countries. The main implementation aspects are described, as well as the main advantages and barriers perceived by the users. Results: The seven case studies showed that adequate staffing, appropriate information technology, availability of hardware, professional collaboration and continuous training are perceived as important factors which can contribute to the implementation of the interRAI instruments. In addition, the use of electronic standardised assessment instruments such as the interRAI Suite provided evidence to improve decision-making and quality of care, enabling resource planning and benchmarking. Conclusion: In practice, the implementation of health information systems is a process that requires a cultural shift of policymakers and professional caregivers at all levels of health policy and service delivery. Information about the implementation process of the interRAI Suite in different countries can help investigators and policymakers to better plan this implementation. This research sheds light on the advantages and pitfalls of the implementation of the interRAI Suite of instruments and proposes approaches to overcome difficulties.
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... A qualitative descriptive design (Sandelowski, 2000;Thorne, Kirkham, & MacDonald-Emes, 1997) was employed to examine barriers and facilitators perceived by home care providers as impacting expansion of PSW roles. A series of 13 focus groups were conducted within four Local Health Integration Networks (LHINs) across Ontario. ...
... Access to read or contribute to specific sections of this electronic medical record could be dependent on provider role, allowing for appropriate access while preserving patient privacy. Though privacy and security details would have to be addressed within the framework of Ontario's privacy laws, a similar system has been successfully developed and implemented in Belgium (Vanneste & Declercq, 2014). Additionally, through a system such as this, opportunities could exist to share standardized assessments already being completed in Ontario by care coordinators (RAI-HC and RAI Contact Assessment) with patient's circle of care to reduce assessment burden on patients (Giosa, Stolee, & Holyoke, 2015;Vanneste & Declercq, 2014). ...
... Though privacy and security details would have to be addressed within the framework of Ontario's privacy laws, a similar system has been successfully developed and implemented in Belgium (Vanneste & Declercq, 2014). Additionally, through a system such as this, opportunities could exist to share standardized assessments already being completed in Ontario by care coordinators (RAI-HC and RAI Contact Assessment) with patient's circle of care to reduce assessment burden on patients (Giosa, Stolee, & Holyoke, 2015;Vanneste & Declercq, 2014). ...
Home-Based care: barriers and facilitators to expanded personal support worker roles in Ontario, Canada
Article
  • Oct 2017
To accommodate increasing demand for homecare in Ontario, Canada, some care tasks traditionally performed by regulated health professionals are being transferred to personal support workers (PSW). However, this expansion of PSW roles is not uniform across the province. Between December 2014 and April 2015, barriers and facilitators to expansion of PSW roles in homecare were explored in a series of thirteen focus groups. Homecare staff identified seven categories of factors affecting the expansion of PSW roles in homecare including: communication and documentation; organization and structures of care; attitudes and perceptions of the expanding PSW role; adequate staffing; education, training and support; PSW role clarity and variation in practices, policies, and procedures. Addressing barriers and promoting facilitators at the funder and employer levels will enable the provision of safe, effective and equitable care by PSWs.
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... In Belgium, the interRAI instruments are com- pleted on the secured online web application: BelRAI (visit belrai.org). This web application enables multi- disciplinary completion of the instruments and sup- ports exchange of client data between healthcare settings, thereby improving the continuity of care (Vanneste & Declercq, 2014;Hermans et al., 2014a). The interRAI PC instrument was imple- mented on the BelRAI web application in 2012 (Hermans et al., 2014a). ...
... Research shows that filling out the interRAI instru- ments is an extensive, laborious, and time-consum- ing process. Care professionals do not always have sufficient time to complete these instruments, espe- cially not in a nursing home, where there is such a heavy workload (Hermans et al., 2016b;Devriendt et al., 2013;Vanneste & Declercq, 2014). A study in Belgian nursing homes showed that it takes about a year to integrate the use of the interRAI PC in the day-to-day practices of a nursing home ( Hermans et al., 2016b). ...
... Our hy- pothesis about a ceiling effect seems to be confirmed. One explanation could be that using an interRAI in- strument reduces residents' needs, independent of what specific interRAI instrument is being used, be- cause it provides an overall picture of the person's needs and leads to a better observation of the nursing home residents and of how care professionals act to fulfill their clients' needs (Devriendt et al., 2013;Hermans et al., 2016b;Vanneste & Declercq, 2014). This may suggest that it would be useful to add specific palliative care items as a supplement to the other in- terRAI instruments rather than working with a sep- arate instrument for use in palliative care situations. ...
Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?
Article
Objective: This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives. Method: A quasi-experimental pretest-posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes. Results: At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items "pain", "other symptoms", "family anxiety", and the total POS score. Posttest POS scores for "wasted time" were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest. Significance of results: One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.
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... It is a person-centred assessment that evaluates the needs and strengths focusing on the person's holistic situation. When the assessment is completed, outcome measures are automatically generated, such as the validated interRAI scales and the Clinical Assessment Protocols (CAPs), which are measures of potential risk or problem situations that can be used to develop a care plan (Carpenter, 2006;Fletcher & Hirdes, 2002;Vanneste & Declercq, 2014). ...
Fall determinants and home modifications by occupational therapists to prevent falls: Facteurs déterminants des chutes et modifications du domicile effectuées par les ergothérapeutes pour prévenir les chutes
Article
Background: Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. Purpose: This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. Method: We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. Findings: The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. Implications: Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.
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... Cognitive status was measured with the interRAI Cognitive Performance scale 2 (CPS2) and depression status was measured with the interRAI Depression Rating scale (DRS) (Hartmaaier et al., 1995; Morris, Carpenter, Berg, & Jones, 2000 ). These scales are internationally validated and are automatically generated when caregivers fill out the interRAI HC instrument (Vanneste & Declercq, 2014). Data analysis was performed in two steps using STATA 11.1 software. ...
The determinants of informal caregivers' burden in the care of frail older persons: a dynamic and role-related perspective
Article
Methods: This was a cross-sectional study including frail older persons aged 65 and above. Instruments used were the interRAI Home Care, the Zarit-12 interview and an ad hoc economic questionnaire. A combination of variables from the Stress Process Model and Role Theory and a sub-group analysis enabled refined multivariate logistic analyses. Results: The study population consisted of 4175 older persons (average age: 81.4 ± 6.8, 67.8% female) and their informal caregivers. About 57% of them perceived burden. Depressive symptoms, behavioral problems, IADL impairment, previous admissions to nursing homes and risk of falls yielded significant odds ratios in relation to informal caregivers' burden for the whole sample. These determinants were taken from the Stress Process Model. When the population was stratified according to impairment, some factors were only significant for the population with severe impairment (behavioral problems OR:2.50; previous admissions to nursing homes OR:2.02) and not for the population with mild or moderate impairment. The informal caregiver being an adult child, which is a determinant from Role Theory, and cohabitation showed significant associations with burden in all strata. Conclusion: Determinants of informal caregivers' burden varied according to stages of impairment. The results of this study can help professional caregivers gain a greater insight into which informal caregivers are most susceptible to perceive burden. Abbreviations: NIHDI: National Institute for Health and Disability Insurance; ZBI12: Zarit Burden Interview - 12 items; InterRAI HC: interRAI Home Care instrument; ADL: Activities of Daily Living; ADLH: interRAI Activities of Daily Living Hierarchy scale; IADL: Instrumental Activities of Daily Living; IADLP: InterRAI Instrumental Activities of Daily Living Performance scale; CPS2: InterRAI Cognitive Performance scale 2; DRS: InterRAI Depression Rating scale.
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Factors associated with informal caregiver's ability to continue care: a subgroup analysis
Article
Background/objective: maintaining informal caregiver's ability to continue care can prevent early institutionalisation and decrease health care costs, contributing to sustainable health care. This study aims to identify factors associated with informal caregiver's ability to continue care across several degrees of cognitive decline and risk of burden. Methods: this is a cross-sectional study that collected nationwide data on frail older people and their informal caregivers living in the community. Instruments used were InterRAI Home Care, Zarit Burden Interview and questionnaire for the informal caregiver. Multivariate logistic regression analyses and a stratification of the population were performed. Results: a total of 8,309 people had at least one primary caregiver, and a majority of them were able to continue care (68.2%). Cognitive impairment was a risk factor for being able to continue care, even the borderline (odds ratios (ORs): 0.72; 95% CI: 0.61-0.85) or mild condition (OR: 0.52; 95% CI: 0.43-0.61). Protective factors like social participation of older people, strong family support and availability of a secondary caregiver showed the highest association in subgroups with mild cognitive impairment (ORs: 2.20, 2.08, 1.64) and in subgroups at low risk of burden (ORs: 1.91, 2.77, 1.64). Conclusion: factors associated with informal caregiver's ability to continue care vary across several degrees of cognitive decline and risk of burden. Interventions related to family and social support resources are recommended, and informal caregivers at a lower level of risk may benefit most. Supportive counselling should be proactively provided to informal caregivers, considering the changes of associated factors with the ongoing caregiving situation.
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The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review
Article
Full-text available
Background Care homes provide long term care for older people. Countries with standardised approaches to residents’ assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents’ everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. Methods The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders’ consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. Results Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents’ data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents’ care Conclusions Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. Registration PROSPERO registration number CRD42020171323.
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Development and evaluation of an intervention on suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE (PROACTIVE): A study protocol based on the Medical Research Council framework
Article
Full-text available
  • Jan 2021
Introduction Caring for people with cognitive problems can have an impact on informal caregivers’ health and well-being, and especially increases pressure on healthcare systems due to an increasing ageing society. In response to a higher demand of informal care, evidence suggests that timely support for informal caregivers is essential. The New York University Caregiver Intervention (NYUCI) has proven consistent effectiveness and high adaptability over 30 years. This study has three main objectives: to develop and evaluate the Flemish adaptation of the NYUCI in the context of caregiving for older people with early cognitive decline; to explore the causal mechanism of changes in caregivers’ health and well-being and to evaluate the validity and feasibility of the interRAI Family Carer Needs Assessment in Flanders. Methods and analysis Guided by Medical Research Council framework, this study covers the development and evaluation phases of the adapted NYUCI, named PROACTIVE—suPpoRting infOrmal cAregivers of older people with early CogniTIVe declinE. In the development phase, we will identify the evidence base and prominent theory, and develop the PROACTIVE intervention in the Flemish context. In the evaluation phase, we will evaluate the PROACTIVE intervention with a pretest and posttest design in 1 year. Quantitative data will be collected with the BelRAI Screener, the BelRAI Social Supplement and the interRAI Family Carer Needs Assessment at baseline and follow-up points (at 4, 8 and 12 months). Qualitative data will be collected using counselling logs, evaluation forms and focus groups. Quantitative data and qualitative data will be analysed with SAS 9.4 software and NVivo software, respectively. Efficacy and process evaluation of the intervention will be performed. Ethics and dissemination This study has been approved by the Ethics Committee of KU Leuven with a dossier number G-2020-1771-R2(MAR). Findings will be disseminated through community information sessions, peer-reviewed publications and national and international conference presentations.
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Development of practice guidelines for daily oral care in care‐dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach
Article
Full-text available
  • Oct 2020
Aim To develop practice guidelines for nursing assistants who provide daily oral care to older adults. Background The interRAI suite of instruments is internationally used in professional health care to assess the needs of care‐dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments. Material and methods The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face‐to‐face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases. Results The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face‐to‐face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines. Conclusion Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults. Implications for practice The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care.
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Comparing the case-mix of frail older people at home and of those being admitted into residential care: A longitudinal study
Article
Full-text available
Background: In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs. Methods: This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up. Results: A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model. Conclusions: The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
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Multidimensional Geriatric Assessment: Back to the Future Second and Third Generation Assessment Instruments: The Birth of Standardization in Geriatric Care
Article
Full-text available
  • Mar 2008
The systematic adoption of “second-generation” comprehensive geriatric assessment instruments, initiated with the Minimum Data Set (MDS) implementation in U.S. nursing homes, and continued with the uptake of related MDS instruments internationally, has contributed to the creation of large patient-level data sets. In the present special article, we illustrate the potential of analyses using the MDS data to: (a) identify novel prognostic factors; (b) explore outcomes of interventions in relatively unselected clinical populations; (c) monitor quality of care; and (d) conduct comparisons of case mix, outcomes, and quality of care. To illustrate these applications, we use a sample of elderly patients admitted to home care in 11 European Home Health Agencies that participated in the AgeD in HOme Care (AD-HOC) project, sponsored by the European Union. The participants were assessed by trained staff using the MDS for Home Care, 2.0 version. We argue that the harmonization by InterRAI of the MDS forms for different health settings, referred to as “the third generation of assessment,” has produced the first scientific, standardized methodology in the approach to effective geriatric care.
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The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: Strengths, weaknesses, opportunities and threats in the acute hospital setting
Article
Full-text available
The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons' medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patient's data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. The primary strengths of the BelRAI-system were a structured overview of the patients' condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat. The BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation.
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The Qualidem project in Belgium. A two-center study on care needs and provision in dementia care: Inclusion criteria and description of the population
Article
Full-text available
  • Jan 2004
Aims: This paper discusses the methodology and results of a three stage diagnostic procedure aimed to select demented subjects and non- demented controls for a prospective field study on the need for care and the primary care provisions for demented persons. Methods: In the first stage, simple assessment of Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and behaviour were used to detect cognitive loss with great sensitivity. In the second and the third stage more specific diagnostic testing was performed among which the Mini Mental State Examination (MMSE) and finally the Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-RN) was used to select demented subjects. At each stage a sample of test 'negative' patients were included as a control group.
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The PATHOS system
Article
  • Jan 1999
The PATHOS system is designed to evaluate the pathological states of elderly patients and define their individual health care requirements. In addition to analysing the health status of these patients, the system enables the level of care to be determined for their management in eight fields: geriatric medicine, psychiatry, nursing, physiotherapy, ergotherapy, psychotherapy, biology, imagery and medical drugs. The article describes the different steps in the elaboration of the PATHOS model and defines the 50 pathological states and 12 types of health care it comprises. Lastly, a pratical coding guide gives advice regarding particular clinical situations.
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Minimum Data Set for Home Care
Article
Background. Optimal care for frail elderly patients depends on comprehensive assessment. This is especially true in the complex setting of interdisciplinary home care programs. To facilitate comprehensive assessment, as well as to generate a useful, policy-relevant patient database, standardized, multidimensional, and validated instruments are very helpful. Objectives. The aim of the present study was to demonstrate that the Minimum Data Set assessment instrument for Home Care (MDS-HC) can be used to detect functional and cognitive impairment as defined by analogous research instruments. Research Design. This was a cross-sectional correlation study. Subjects. We studied 95 patients admitted to home care services of the Health Care Agency of Bergamo (Italy). Measures. The MDS-HC form was completed for all patients by well-trained nurses, independently of and with nurses blinded to the results from the research rating scales. The Barthel Activities of Daily Living (ADL) Index, the Instrumental Activities of Daily Living of Lawton (IADL), and the Mini Mental State Examination (MMSE) were considered the gold standard. Results. Agreement between the MDS-HC scales and the research rating scales was assessed with Pearson’s correlation coefficient. This coefficient was 0.74 for MDS-ADL versus Barthel Index, 0.81 for MDS-IADL versus Lawton Index, and 0.81 for Cognitive Performance Scale versus MMSE, indicating an excellent agreement. Conclusions. The MDS-HC scales, when performed by trained nurses using recommended protocols, provide a valid measure of function and cognitive status in frail home care patients. These findings point out the overall validity of the functional and clinical data contained in the MDS-HC assessment. Use of the MDS-HC gives the unique opportunity of setting up a database, a prerequisite for all epidemiological evidence-based medicine studies.
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