Revised May 29, 2009
A1
The CAN-STRIVE Study: A Day In The Life
Presenter: Micaela Jantzi
The Canadian Staff Time and Resource Intensity Verification (CAN-STRIVE) study is funded by the Ontario Ministry of Health and Long Term Care (and CIHI) and is designed to provide Canadian evidence to validate and refine the Resource Utilization Groups (RUG-III) case mix system. Based on items from the RAI 2.0 assessment, the RUG-III system has been used as part of the funding formula in Ontario's Complex Continuing Care (CCC) hospital beds since 2001 and is currently being implemented in Long-Term Care (LTC) homes across the province. This presentation will provide an overview of this study as well as some of the outcomes.
Visibility Improving: Who’s who in Canadian Long-term Care Homes
Presenter: Maureen Kelly
This presentation will highlight an emerging portrait with data from the CIHI Continuing Care Reporting System. The analysis will examine the similarities and differences in long-term care residents, facilities and services across Canada to contribute to an understanding of this diverse and increasingly important sector.
Computerized MDS Data--Eleven Years Later
Presenter: Carol Job
This presentation will highlight how the MDS data has been used in care planning,
payment, and quality monitoring in the USA. It will also provide new information
on how the MDS data is used to reward USA nursing home providers who are providing
excellent quality care to their residents as well as the development of the
new RUG-IV classification system.
A2
Determining the most appropriate care setting for seniors: Implications for policy across the continuum of care.
Presenter: Norma Jutan
As the Canadian population ages we will require that services be carefuly allocated and care be provided in the appropriate and least intensive care setting in order to sustain the health care system. This study uses data from interRAI CHA, RAI-HC, MDS 2.0, along with focus groups input to develop a decision support tool to assist clinicians around resource allocation and service planning. This presentation will review the settings were clients reside, staff ratings regarding the appropriateness of the settings, the criteria used to formulate the decision tool and the ongoing need for community support for our aging population.
Low-Need Older Adults in Long-Term Care Facilities: Why?
Presenter: Lori Mitchell
A recent examination of older adults residing in long-term care facilities (LTCF) in the Winnipeg Health Region identified a wide range of abilities and conditions among the residents. This study linked RAI 2.0 assessments with RAI-Home Care (RAI-HC) assessments and undertook an electronic chart review of Home Care records for a cohort of low-need residents in LTCF in Winnipeg, Manitoba. This study identified a number of factors related to LTCF admission of low-need older adults. System changes and the potential to keep these older adults in the community in the future are discussed.
Potential Use of RAI Data to Inform Practice across the Care Continuum
Presenter: Teresa Coles
For the first time in Vancouver Coastal Health Authority (VCHA) RAI assessment data, RAI-HC and RAI-LTC, crossed the care continuum opening further possibilities to inform practice. Despite similarities in RAI-HC outcomes for clients placed in residential care facility, critical questions remain. Are clients placed from home and from acute care settings truly the same? Do the care trajectories differ? What may be learned by following these clients and linking to their residential care outcomes? To begin examining these questions, client RAI-HC outcomes were linked to their RAI-LTC outcomes and compared. Each outcome examination, however, reveals variance in the degree of change between clients placed from home and from acute care settings.
Linking RAI-HC to RAI-MDS
Presenters: Mary Henderson-Betkus & David Price
Using multiple RAI tools improves continuity along the continuum of care. This
presentation provides a practical demonstration of clinical utility of RAI-HC
in another practice area such as residential care where the RAI - MDS 2.0 is
used.
A3
Multi-jurisdictional 2.0 Implementation with Interdisciplinary Approach
Presenters: Sharen Wilson Carr & Donna Melton
An overview of a project plan for the pan-Canadian roll out of RAI to 90 long term care sites including roles and responsibilities of the corporate team, key success factors, challenges faced, lessons learned to date and next steps such as comparing quality data across the country.
60 Minute Continuing RAI Education Teleconferences
Presenters: Elizabeth Rigley & Sandra Schmidt
An Innovative Education Strategy to Enhance RAI-MDS 2.0 Knowledge & Practice Across Ontario Long-Term Care Homes.
This presentation will highlight an innovative method of providing RAI-MDS 2.0 continuing education to Ontario long-term care homes using audio-conferencing and posting of the taped sessions on a portal website for future reference. Topics selected are those relevant to the implementation of the RAI-MDS 2.0.
BelRAIWiki: an elegant assessment support tool for Belgian caregivers using BelRAI
Presenter: Dirk Vanneste
Description of a web based application developed in Belgium which allows a multidisciplinary approach during and after RAI assessment. A unique feature of the Belgian online web application (BelRAI) is that each caregiver completes online instrument parts related to their area of expertise.
In addition to support the use of BelRAI, a second multilingual website (BelRAIWiki) has been constructed as an online manual. Every BelRAI item or outcome is linked to BelRAIWiki, so that every specific detail or explanation caregivers should know is just one click away.
A4
RAI 2.0, P.I.E.C.E.S. and Montessori – Enhancing Quality of Life for Residents of Long Term Care Homes
Presenters: Leslie Orlikow, Karen Bauer & Marijana Muretic
While RAI is critically important in the provision of quality care, other initiatives are being implemented to enhance the lives of residents. This presentation will show how the RAI may be used with Montessori-based programs and P.I.E.C.E.S. to help in assessing, understanding the challenges, and enhancing the quality of life for the older person. The presenters will explain that the use of these assessment tools will not result in the duplication of assessment effort even though the three assessment tools have similar characteristics. They will provide, as well, an evaluation of their interventions through a combination of RAI data analysis and story telling.
FROM CAPS TO OUTCOMES: An Electronic Care Plan
Presenter: Carol Barr
This presentation will discuss the Rural Shared Health Information Partnership
(RSHIP) in Alberta's implementation journey of the RAI 2.0, electronic care
plans, and decision support tools. The benefit of automating RAI outputs
to support clinical decision-making and their experience with making technology
effective in supporting clinical practice will be presented.
A Maiden's Voyage – From a Dory to a Cruise Ship
Presenters: Cynthia Fraser & Sharon Specht
This presentation will outline the implementation journey of the RAI 2.0 in Yukon Continuing Care facilities. The importance of an integrated assessment process using the RAI 2.0, use of innovative strategies, and how a partnership and transdisciplinary care plans can improve outcomes will be highlighted.
RAI Conversion – The Process of the Non-Believer Becoming a RAI 2.0 Convert
Presenters: Nancy Kidd & Gail Nardi
Over the last 6.5 years, Yukon Continuing Care team members have become strong advocates and users of the RAI 2.0 assessment and outputs. The presenters will share RAI 2.0 success factors and strategies as they pertain to the individual and the trandisciplinarycare team. What worked, as well as those things that didn’t work, will be reviewed as they relate to engaging team members, through altering business processes, and providing team supports in the creation of the RAI 2.0 culture actively using RAI outputs in decision-making and care planning.
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Concurrent Sessions B Tuesday, June 23 1:30 pm - 3:00 pm |
B1
Using RAI Data in Pharmacoepidemiologic Research: Heart Failure Management in Home Care
Presenter: Andrea Foebel
This presentation will introduce methods used in working with and
extracting medication data from the RAI-HC database. This presentation
will also present results from research into heart pharmacotherapy in
home care, and highlight strengths of using this information and
current barriers to working with medication data.
RAI-HC: Making the Connection Between the Assessment and the DATA
Presenter: Ian Ritchie
The North West Community Care Access Centre in Thunder Bay, Ontario utilizing the standardized assessment tool (RAI-HC) has developed a simple scoring system based on five outputs from the RAI-HC to target the frail elderly living in the community. The purpose of this scoring system is to ensure that the frailest elderly clients are targeted with the proper case management program and appropriate service levels.
Contrasting three frailty conceptualizations in their ability to predict negative outcomes for home care clients
Presenter: Joshua Armstrong
Frailty is a complex concept with many definitions and no consensus. This presentation compares 3 conceptualizations of frailty. The frailty measures include the Edmonton Frail Scale, the Accumulation of Deficits Frailty Index, and the Changes in Health, End-Stage Disease and Signs and Symptoms scale. Each frailty measure will be compared in its ability to predict institutionalization and death in home care clients.
B2
Application of statistical approaches to examination of the quality of RAI-MDS 2.0 from Saskatchewan special care homes.
Presenter: Gary Teare
This presentation will show how the quality of the Saskatchewan RAI (MDS 2.0)
data was examined through application of statistical tests of reliability and
internal validity as well as an examination of the completeness of the data.
Findings from Saskatchewan data are compared to results of similar analyses
conducted using Ontario data from Complex Continuing Care facilities (Hirdes
et al., 2007). Learnings from this presentation are geared to approaches used
to evaluate RAI data quality that is remote from the LTC homes where the data
are collected and to show some of the strengths and limitations of the Saskatchewan
data.
How RAI 2.0 Supports Us in the Accreditation
Presenters: Leslie Orlikow & Marion Pringle
After reviewing Qmentum, Accreditation Canada's current standards, it is clear that much of RAI 2.0 can be used to provide evidence during the accreditation process This presentation will provide an overview of where RAI 2.0 and its applications support the Qmentum Required Organizational Practices, such as: Culture, Communication, Medication Use, Worklife/Workforce, Fall Prevention and Risk Assessment.
The Quest for Quality: Utilizing MDS Measures to Monitor Resident Medications
Presenters: Charmayne LeRuyet & Cassandra Klassen
The session will provide an overview of the data quality review completed on
3 MDS Quality Indicators (QIs) across 24 LTC sites in the Regina
Qu'Appelle Health Region.
B3
Using the Traumatic Life Events Clinical Assessment Protocol (CAP) to Assist in Care Planning
Presenter: Krista Mathias
Mental Health Clinical Assessment Protocols (CAPs) provide an evidence-based approach to using information. The Traumatic Life Events CAP sometimes triggered by completion of the RAI-MH or RAI Community Mental Health tool will show who may benefit from additional supports or formal services targeted towards trauma treatment
The Mental Health Quality Indicators based on the RAI-MH: Design and Applications
Presenters: Chris Perlman
This presentation will review the quality measurement applications of the RAI-MH
with specific attention on the refinement of an inventory of mental health quality
indicators (MHQIs) based on the RAI-MH. It will also introduce how the
RAI for Mental Health can improve understanding and sharing of best practices
through quality measurement.
The Development and Implementation of the RAI-MH: A Step in the Right Direction, Integrating the Information to Support Recovery
Presenters: Sandy Cantin & Crystal Norman
The implementation and ongoing development of the RAI-MH instrument has enabled Northeast Mental Health Centre (NEMHC) to provide our patients with a holistic, comprehensive, and recovery model based, multidisciplinary plan of care. Documents and additional instruments in relation to the RAI-MH were identified and a new Multidisciplinary Treatment Team Conference Note was developed. The various programs were encouraged to make the additions that they required to make the note functional for their service. With the use of the RAI-MH Quick Links, the staff is now able to access all documents and available resources to assist with the completion of the assessment and the successful use of the RAI-MH in the development of the treatment plan.
Exploring Hospital Mental Health Service Use in Ontario
Presenter: Lezlee Cribb
CIHI will demonstrate how the use of data collected with the Resident Assessment Instrument for Mental Health (RAI-MH©) in Ontario can provide clinical outcomes data and information about the characteristics of people, hospitalized for mental health.
B4
Using RAI-MDS data to assess the risk of resident falls in long term care facilities
Presenter: Edgar Ramos Viera
Falls are a major contributor to impaired mobility in older adults and the leading cause of injury and death due to injuries among older Canadians (65+). This presentation will show the results of systematic literature review and the work to determine what RAI-MDS variables in addition to the current Falls' RAP triggers may be used to further improve the sensitivity of the Falls' RAP in a model that predicts falls among long term care residents.
Discoveries for Those who take the Journey
Presenter: Betty Matheson
Betty will provide some of the "joys" of MDS 2.0 use after 9 years of implementation- a touchy, caring, hands on approach to the benefits of MDS because as nurses improved resident care is the most important out come.
Nutrition Care - Incorporating RAI process in interdisciplinary practice
Presenter: Soo Ching Kikuta
The presentation will demonstrate how the RAI-MDS 2.0 can be applied to nutrition care in an interdisciplinary setting and provide practical strategies for meeting different RAI implementation challenges in long-term care homes.
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Concurrent Sessions C Tuesday, June 23 3:30 pm - 5:00 pm |
C1
Launching Technology in a Sea of Practice
Presenters: Cheryl Olson
A description of how one health region launched technology in Home Care in four phases: assessment of readiness, mobile pilot, full tablet deployment and tablet optimization. Evaluation results, staff feedback, action plans, education and change management strategies will be presented.
Facilitating Change: Implementation Strategies for Easing the Transition to Electronic Charting in Home Care
Presenter: Signe A. Swanson
The transition from recording clinical information on a paper chart to an electronic one involves a significant paradigm shift for health care professionals in technical skills and thinking process. The implementation plan for rolling out the electronic version of the RAI-HC, care planning, and clinical charting in community in the region formerly known as East Central Health, includes education and communication strategies which take into account this paradigm shift. This presentation will outline the critical elements of the implementation plan and the principles used in its development.
Voyaging with the RAI-HC: A Training and Support Model
Presenters: Janice Cruikshank & Trisha LeClair
The Nova Scotia model for training and support for the RAI-HC assessors
recognizes accessibility to ongoing training and support as essential
components for data quality.
The RAI-HC was fully implemented in Nova Scotia in May 2002 following a
one year demonstration project in 2 of the 9 provincial districts.
The training model has continued to evolve and in 2009 there are 4
permanent Clinical RAI Specialists who guide new and experienced
assessors in the correct and consistent use of the RAI-HC tool as well
as the use of the software known as SEascape that supports the use of
the tool.
Ahoy Mate! Do you understand RAIspeak? Educating Continuing Care to the RAI Vocabulary
Presenter: Linda Dieltgens
Terms such as CHESS, CAPS, and Cognitive Performance Scales which are inherent in the RAI-HC and become part of the everyday vernacular of users, thus creating a language that can be termed "RAIspeak". This presentation describes how to achieve fluency in this language for both users and interpreters of data.
C2
The interRAI Pressure Ulcer Risk Scale (PURS) – The Outcome of Applied Research to Reduce Assessment Duplication
Presenters: Jeff Poss, Gail Woodbury, Shirley MacAlpine, Patsy Morrow, Nancy Curtin-Telegdi
The Ontario MOHLTC Wound Care and Prevention Committee approved the Canadian Association of Wound Care (CAWC) to run a pilot Pressure Ulcer Awareness and Prevention (PUAP) Program in Ontario LTC Homes. However, it soon was apparent that in homes using the RAI-2.0, assessment burden was inappropriately high, as they used and reported the Braden Scale for Pressure Ulcer Risk as part of the PUAP, along with similar assessment elements in the RAI-2.0. A result of RAI-2.0 data analysis was the development of the interRAI Pressure Ulcer Risk Scale (PURS). This presentation will highlight the power of bringing together clinicans and researchers around an important clinical issue. Validation findings will be presented from long term care homes, complex continuing care hospitals, and home care. Provincial comparisons will also be shown.
C3
Resident-Directed Care Guide System
Presenter: Laureen Nein
An interdisciplinary care planning system that incorporates resident-directed care and the Resident Assessment Protocols (RAPs) from the RAI-MDS 2.0 will be presented as well as strategies to overcome challenges in creating an interdisciplinary care guide and data collected pre and post implementation to support achievement of the goal of improving communication amongst care team members.
Care Planning that Makes a Difference
Presenter: Theresa Gatien
This presentation is founded in the experience of using the RAI 2.0 by
Yukon Continuing Care over the last 6.5 years. The presentation will
disucss a peer organization's definition of care planning and successful
strategies for developing and maintaining a successful care planning
process using the RAI 2.0 outputs that meets industrial standards and
improves the quality of care.
Integrating Survey and RAI Data for a Balanced View of Quality of Care in Alberta Long Term Care Centres
Presenters: Charlene McBrien-Morrison & Tim Cooke
This presentation will focus on the value of integrating interRAI LTCF assessment quality indicator data with data collected from long term care resident and family experience surveys. Providing three coordinated points of reference provides more comprehensive and rigorous information for planning quality improvement efforts that can be utilized at the regional, organizational and provider level. The participant will learn about the CAHPS resident and family experience tool that was specifically designed to be used in conjunction with the InterRAI LTCF quality indicators as well as gain a more complete and balanced view of the quality of care and services through the integration of resident and family experience data and interRAI LTCF quality indicator data.
| Concurrent Sessions D Wednesday, June 24 9:00 am - 10:30 am |
D1
Utilizing the RUGsIII/HC for Resource Allocation
Presenters: Glenda Stein & Cheryl Grady
The Calgary Home Care program utilizes standard guidelines to support allocation of professional and support services to long term supportive and maintenance clients living in their homes, however there exists a wide variation between care plans and services provided for similar clients. This presentation explores the feasibility of using RAI outcomes to support a consistent and explicit method of allocating limited resources. It will also present the methodology and outcomes of the pilot study.
Safety Indicators for Canadian Home Care Clients: Evidence From the RAI-HC Measurement System
Presenter: Diane Doran
This study presents the usefulness of the RAI-HC assessment instrument in assessing the burden of safety problems among Canadian homecare clients. The WHO conceptual framework for international classification for patient safety was used to guide the conceptualization of home care safety indicators. A secondary data analysis using data from Canadian Home Carte Reporting System from Ontario, Nova Scotia and Winnipeg revealed valuable information about adverse outcomes and risk factors for home care clients.
D2
Mind The Gap? An Examination of Ontario RAI-HC Reassessment Intervals
Presenter: Jeff Poss
Case managers of long stay adult home care clients in Ontario are expected to conduct a RAI-HC assessment at the beginning of the episode, and again every six months. Compliance with this guideline since 2006 appears good on average, however, there is some variability. Clinical characteristics that appear to drive earlier versus later reassessment will be presented. In addition, individual client change at reassessment will be shown in order to better understand the RAI-HC's ability to detect clinical change over time.
Beyond Assessment: How to increase use of the RAI-HC by using meaningful information for understanding caseload and population needs
Presenter: Jamie Arthur
This presentation describes the challenges faced by an Ontario CCAC in achieving their goal of assessing 95% of their clients with the RAI-HC© by March 2009 to provide high quality information for implementing a new case management model. Lessons learned will be shared.
Recognizing and Preventing RAI Drift: Improving data quality via ongoing support to prevent assessors from drifting away from the original intent of questions in the RAI
Presenter: L. P. Suzanne Atkinson
As we collect data, analyze that data, make plans for the future based on that data - are we sure that assessors are actually scoring the assessment based on the manual and the stated intent of each question. Are we giving our assessors enough support and reinforcement to insure that their scoring continues to reflect intent? Are we sure?
Definition of RAI Drift:
The act of scoring on a continuum that is gradually moving away from the original intent of the question. Over time, and with repeated assessments, accepting the influence of both the client and other assessors to come to an interpretation different than the RAI standard.
D3
Improving the Use of RAI-HC Data for Rehabilitation Clients in Home Care
Presenter: Katherine Berg
This study explores the barriers and facilitators for sharing health information for home care clients and using RAI data by rehabilitation professionals in home care practice. Over 40 individuals participated in three knowledge exchange panels. Participants described time, caseloads, non-integrated information systems, and inconsistent expectations for documenting and sharing information as barriers to information use. Possible strategies for improving the use of health information included more education on potential utility of RAI assessments and standardized policies to govern what and when client information can be shared. Participants provided input on future analyses on exiting RAI home care databases to inform practice.
Using CAPs data at organizational and system levels: Can we learn something new about our Home and Continuing Care populations?
Presenter: Nancy White
This presentation will illustrate the potential uses of CIHI aggregate information on the new interRAI CAPs triggered over time and across jurisdictions. This information provides a unique view of home and continuing care populations and may be used to support not only clinical but also management decisions.
interRAI Assessment, CAPs, and Outcome Measures: A Powerful Synergy
Presenters: Nancy Curtin-Telegdi and Leslie Eckel
This presentation shows the significance of the assessment information, CAPs
and Outcome Measures, in supporting the development of person-centered care
plans. Integrating these multiple sources of information creates a synergistic
power that can generate a comprehensive picture of the person’s needs,
strengths, and preferences providing the foundation for sound decision-making.
Underlying principles will be emphasized to help front-line clinicians apply
the assessment information, CAPs and Outcome Measures in the development of
person-centered care plans.
D4
Medication Use as a Risk Factor for Falling among Older Adults in Ontario
Presenter: Dawn Dalby
Understanding the needs of ALC patients waiting for long-term care in the context of community care
Presenter: Andrew Costa
This session will review research to compare the Alternative Level
of Care (ALC) populations to that of elderly long stay home care clients
in Ontario using a variety of items and scales imbedded in the RAI-HC (RAI-HC).
Symptom clusters in community-based palliative
Presenter: Trevor Smith
