Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system

<p>Abstract</p> <p>Background</p> <p>A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument comprises items common to other instruments and specialized items exclusive to that instrument. This study examined the reliability of the items from five instruments supporting home care, long term care, mental health, palliative care and post-acute care.</p> <p>Methods</p> <p>Paired assessments on 783 individuals across 12 nations were completed within 72 hours of each other by trained assessors who were blinded to the others' assessment. Reliability was tested using weighted kappa coefficients.</p> <p>Results</p> <p>The overall kappa mean value for 161 items which are common to 2 or more instruments was 0.75. The kappa mean value for specialized items varied among instruments from 0.63 to 0.73. Over 60% of items scored greater than 0.70.</p> <p>Conclusion</p> <p>The vast majority of items exceeded standard cut-offs for acceptable reliability, with only modest variation among instruments. The overall performance of these instruments showed that the interRAI suite has substantial reliability according to conventional cut-offs for interpreting the kappa statistic. The results indicate that interRAI items retain reliability when used across care settings, paving the way for cross domain application of the instruments as part of an integrated health information system.</p

A feasibility randomised controlled trial of the New Orleans intervention of infant mental health: a study protocol

Child maltreatment is associated with life-long social, physical, and mental health problems. Intervening early to provide maltreated children with safe, nurturing care can improve outcomes. The need for prompt decisions about permanent placement (i.e., regarding adoption or return home) is internationally recognised. However, a recent Glasgow audit showed that many maltreated children “revolve” between birth families and foster carers. This paper describes the protocol of the first exploratory randomised controlled trial of a mental health intervention aimed at improving placement permanency decisions for maltreated children. This trial compares an infant's mental health intervention with the new enhanced service as usual for maltreated children entering care in Glasgow. As both are new services, the trial is being conducted from a position of equipoise. The outcome assessment covers various fields of a child’s neurodevelopment to identify problems in any ESSENCE domain. The feasibility, reliability, and developmental appropriateness of all outcome measures are examined. Additionally, the potential for linkage with routinely collected data on health and social care and, in the future, education is explored. The results will inform a definitive randomised controlled trial that could potentially lead to long lasting benefits for the Scottish population and which may be applicable to other areas of the world

Descriptive, Comparative, and Correlational Study Related to End-of-Life Care Prior to the Covid-19 Pandemic Outbreak (Time 1) and 12 Months Following Lockdown (Time2)

Background Palliative care has grown in its acceptance nationally and formed the base of a growing number of programs to provide care in a way that recognizes the importance of supporting people with chronic, debilitating, and life-limiting illnesses by focusing on “care” rather than “cure.” This special care warrants an understanding by all nurses and requires education across specialties and disciplines. Despite the increase of palliative care services in hospitals and other settings, long-term care and home care agencies continue to struggle with the education of staff and delivery of care to clients that incorporate the central tenets of what has been defined by the Guidelines for Quality Palliative Care developed by the National Consensus Project (National Coalition for Hospice & Palliative Care, 2018). Numerous educational programs have been developed to train physicians, nurses, and others to improve communication skills, reduce pain and manage symptoms, and foster an environment that supports patients nearing death and their families. While there has been research on the education of health care providers on palliative care, little of this research has been done in the home health care setting. To incorporate palliative care into this setting, the health care providers on the home care team need to be adequately trained to increase their comfort with and knowledge of palliative care. Some of the providers’ understanding and confusion of palliative and hospice care may need resolving, and some of their personal beliefs about end-of-life (EOL) treatment and palliative care may be barriers to their readiness to participate in a change of treatment and care goals, which may include their own fear of death or personal negative experiences with dying loved ones. Purpose While palliative care services are underutilized under the best circumstances, the emergence of COVID19 has further highlighted the importance of and vital need for palliative and EOL care. Already overburdened health care systems due to COVID-19 are faced with the challenge of administering safe and effective palliative and EOL care. For this study, two time periods were anchored by the two data collection points: pre- COVID-19, referred to as TIME 1: one year prior to the outbreak of COVID-19 in New York (January 2019) and TIME 2: approximately one year after the outbreak of COVID-19 in New York (February/March 2021) when home care services had been altered by emergency and EOL care needs due to the COVID-19 pandemic. The purpose of the study is to compare and determine if correlations exist related to palliative and EOL care between Time 1 and Time 2 involving health care providers’ comfort with, attitudes toward, and fear of dying. Specifically, this study examines the interprofessional home care team in a large multi-hospital system to (a) describe professionals’ characteristics, comfort with and attitudes about EOL treatment and palliative care, and their fear of death at Time 1 and (b) compare them with Time 2 characteristics, comfort, attitudes, and fear of death. It also includes an examination of the relationship of these characteristics with the home care staff’s selfreported professional self-confidence in EOL caregiving. Method This study used a descriptive, pre- and post- comparative, and correlational design of multi-professional home care providers’ comfort with, attitudes toward, and fear of dying before and after Time 1 and Time 2. The pre-survey (Time 1) was used prior to the pandemic to determine which characteristics of home care providers influence their comfort with and attitudes about palliative and EOL care, and fear of dying. The post-survey (Time 2) compares these previously recorded variables with their self-reported selfconfidence in EOL caregiving, an educational assessment tool in the subscales of cultural and ethical values; patient and family- centered communication; and effective care delivery. The study sample was recruited from the roster of all professional health care providers at a large, certified home health care agency (CHHA). Participants included registered nurses (RNs), physical therapists (PTs), occupational therapists (OTs), speech therapists (STs), and medical social workers (MSWs) (n = 601) who were employed at and made home visits for the CHHA with an average daily census of 3,000 patients. The Time 1 survey was distributed in January 2019. A total of 33% of the surveyed providers responded (n = 200). The Time 2 survey was distributed to the same agency roster in April 2021; due to some attrition and some newer employees in the organization, there was some expected variation in the Time 2 sample population. This survey yielded a suitable expected sample for the proposed analysis of \u3e180 providers. The measures include instruments developed for the study and pre-tested for reliability including items to measure comfort (Comfort in Providing Palliative Care [CPPC]); the Collett- Lester Fear of Death Scale with reported validity and reliability, which includes four subscales: Fear of Death, Fear of Dying, Fear of Others Death, Fear of Others Dying; and F-S Hospice Scale: Views on Hospice Care to measure attitude toward hospice (Attitude Toward Hospice Scale [ATHS]). The dependent measure of the Time 2 sample is the End-of-life Professional Caregiver Survey (EPCS) instrument used frequently to assess educational needs of staff in the clinical practice domains of palliative care. The subscales include (a) Cultural and Ethical Values (CEV) (8 items), Patient and Family Centered Communication (PFCC) (12 items), and Effective Care Delivery (ECD) (8 items). Results The results are a descriptive analysis of all measures related to home care providers’ EOL comfort, attitudes, and fear of dying; a comparative analysis of EOL comfort, attitudes, and fear of dying before and after the onset of the COVID-19 pandemic; and a regression analysis of related variables with the educational needs identified in the self-reported EPCS subscales. Summary and Recommendations This study explored the relationship between home health care providers’ personal characteristics and their comfort with and attitudes toward hospice and palliative care, and fear of death and dying of self and others. The findings of the study yielded significant results regarding staff level of comfort, attitudes, and fear of death and dying in relation to staff personal characteristics. The study demonstrated changes in staff comfort and attitudes toward palliative and EOL care during the onset of the pandemic. Differences were seen between Time 1 and Time 2 in staff level of comfort in discussing the dying process, attitudes toward hospice related to pain control, feelings toward fear of death (self) in the measure of death and the shortness of life, feelings of fear about dying away from others, and feelings about the dying (others) as a reminder of their own death. The study results also identified certain predictors for staff self- reported EPCS in the domains of personal characteristics, level of comfort with, and attitudes about providing EOL and palliative care services. Further research is needed to guide future policies and programs to improve access to family-centered palliative care during a global health crisis such as the COVID-19 pandemic need to be implemented. An investment in further research and the resultant policy changes from the study findings can further support home health care workers in caring for patients and families at end of life

Reliability of Standardized Assessment for Adults who are Deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems

Developing an integrated geriatric care planning approach in home care

Introduction The demand for home care services in Canada is on the rise, as older adults wish to remain in their own homes as long as possible and deinstitutionalization of care continues to promise significant savings to the system (Better Home Care, 2016, p. 90). The provision of home care services to the older population is complicated by their increased likelihood to have two or more chronic health conditions and tendency to require care from multiple providers to meet their often complex physical, functional, social, cognitive and psychosocial needs (Health Council of Canada, 2012; Statistics Canada, 2015). In Ontario, home care service allocation, care planning and care delivery are further fragmented as a result of the multi-layered and complex funding and coordination model that exists across the province (Health Quality Ontario, 2012; Local Health Integration Networks, 2014a). More integrated care planning at the point-of-care has the potential to improve the delivery and experience of person- and family-centred geriatric home care (Harvey, Dollard, Marshall, & Mittinty, 2018). This study aimed to develop an implementation framework for a new integrated geriatric care planning approach, at the point-of-care in home care. Key objectives included: a) to investigate the geriatric assessment practices of point-of-care providers; b) to collect ideas from older adults and their family/friend caregivers for improving person-and family-centred goal-setting; and c) to co-design solutions for more integrated geriatric care planning with older adults, their family/friend caregivers and point-of-care providers. Methods The Medical Research Council (MRC) Framework for Developing Complex Interventions and the Co-creating Knowledge Translation Framework guided this study (Craig et al., 2013; Powell et al., 2013). A sequential transformative mixed methods design from a pragmatic theoretical lens was applied, using an ideology of collective creativity to meaningfully engage older adults, their family/friend caregivers, and point-of-care providers (Creswell, Clark, Gutmann, & Hanson, 2003; Feilzer, 2010; Sanders & Stappers, 2008; Sanders & Stappers, 2012). Phase one data collection involved scoping the literature, clinical expert key informant interviews (N = 7) and a web-based survey of point-of-care providers (N = 350). Phase two data collection involved solutions-focused key informant interviews with older adults and their family/friend caregivers (N = 25). Quantitative data analysis involved psychometric testing and descriptive statistics. Qualitative data analysis involved inductive and deductive coding techniques and framework analysis (Gale, Heath, Cameron, Rashid, & Redwood, 2013; Lofland, Snow, Anderson, & Lofland, 2006). The data were brought together as an implementation framework during the interpretation phase of this research through a co-design workshop with older adults, their family/friend caregivers and point-of-care providers (N = 19). Results A new survey for assessing geriatric care assessment practices (G-CAP survey) was developed and demonstrated acceptable test-retest reliability (M ICC = 0.58; M kappa = 0.63), discriminative (M t = 3.0; M p = 0.01) and divergent/convergent (M r= |0.39|) construct validity for use with point-of-care nurses, occupational therapists and physiotherapists in home care. Survey data revealed that point-of-care providers use their observation and interview skills (M = 4.50 on a 5 point scale where 1= never and 5= often-always) far more often than standardized assessment tools for client assessment (M = 1.72) and rarely share assessment data with or receive assessment from other providers (M =3.75; M =3.46). Interview data indicated that older adults and their family/friend caregivers want to be engaged in conversations about their goals in relation to their daily lives, personal background and medical history. An implementation framework for integrated geriatric care planning at the point-of-care emerged, involving three key influencing factors: 1) inclusive assessment practices; 2) dialogue-based goal-setting; and 3) flexible communication strategies. Conclusions Integrated care planning for service allocation and point-of-care delivery in geriatric home care would be better supported by assessment, goal-setting and communication practices that equally address the information needs and person- and family-centred care experiences desired by older adults, their family/friend caregivers and point-of-care providers in order to promote virtual home care teams. Future research should focus on prototyping strategies, technology, tools and evaluation criteria and measures to operationalize the implementation framework

Home-based reach-to-grasp training for people after stroke: study protocol for a feasibility randomized controlled trial

BackgroundThis feasibility study is intended to assess the acceptability of home-based task-specific reach-to-grasp (RTG) training for people with stroke, and to gather data to inform recruitment, retention, and sample size for a definitive randomized controlled trial. Methods/designThis is to be a randomized controlled feasibility trial recruiting 50 individuals with upper-limb motor impairment after stroke. Participants will be recruited after discharge from hospital and up to 12 months post-stroke from hospital stroke services and community therapy-provider services. Participants will be assessed at baseline, and then electronically randomized and allocated to group by minimization, based on the time post-stroke and extent of upper-limb impairment. The intervention group will receive 14 training sessions, each 1 hour long, with a physiotherapist over 6 weeks and will be encouraged to practice independently for 1 hour/day to give a total of 56 hours of training time per participant. Participants allocated to the control group will receive arm therapy in accordance with usual care. Participants will be measured at 7 weeks post-randomization, and followed-up at 3 and 6 months post-randomization. Primary outcome measures for assessment of arm function are the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). Secondary measures are the Motor Activity Log, Stroke Impact Scale, Carer Strain Index, and health and social care resource use. All assessments will be conducted by a trained assessor blinded to treatment allocation. Recruitment, adherence, withdrawals, adverse events (AEs), and completeness of data will be recorded and reported. DiscussionThis study will determine the acceptability of the intervention, the characteristics of the population recruited, recruitment and retention rates, descriptive statistics of outcomes, and incidence of AEs. It will provide the information needed for planning a definitive trial to test home-based RTG training. Trial registrationISRCTN: ISRCTN5671658

Psychometric Properties of the Readiness for Hospital Discharge Scale

The purpose of the study was to assess the psychometrics properties of the Readiness for Hospital Discharge Scale (RHDS), a 23-item instrument that measures patients\u27 perception of readiness for discharge. Data were obtained from 356 respondents from two urban tertiary medical centers (adult and children\u27s) in the midwestern United States who were participants in a larger study of predictors and outcomes of readiness for hospital discharge. Confirmatory factor analysis, contrasted group comparisons, and predictive validity testing supported the 4-factor structure and construct validity of the instrument. Following deletion of two poorly performing items, Cronbach\u27s alpha for the revised 21item scale was 0.90. The RHDS can be a useful tool for measurement of readiness for discharge for clinical and research purposes

The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Preventing Delinquency Through Improved Child Protection Services

Research indicates that the prevalence of child abuse or neglect among delinquent offenders is substantially greater than it is among the general population. Moreover, maltreated children are significantly more likely to become involved in delinquent behavior than their nonmaltreated peers, and delinquent youth with a history of abuse or neglect are more likely to continue their offending behavior than delinquents who have not suffered child abuse or neglect. Given the links between child maltreatment and juvenile offending, designing and implementing programs to reduce the incidence of child maltreatment as a means of preventing delinquency are a promising -- though often overlooked -- strategy.After reviewing what is known about the links between childhood maltreatment and juvenile and adult offending, the authors review OJJDP's Comprehensive Strategy for Serious, Violent, and Chronic Juvenile Offenders and examine the role that child protective services' prevention efforts can play in delinquency prevention and intervention