An Overview of the interRAI Suite
Many people with chronic illness or disability use a variety of clinical and support services. This may occur simultaneously for example, individuals may use both mental health and personal assistance services — or sequentially — they may use community supports, then transfer to hospital, then transfer again to a post-acute care setting. A number of years ago, interRAI identified the need for compatible assessment instrumentation that could be used across health care sectors. After a complex “restructuring” process we released our first iteration of the integrated suite in 2005. Over time, other instrument systems have been added to the suite.
Suite instruments are built on a “core” set of assessment items that we consider important in all care settings. These common items have identical definitions, observation time frames, and scoring. Additional items specific to a particular care population or care setting are then added to the core item set.
To view the Table of Contents for our published manuals, please visit our online catalog. For more information about specific instrument systems, contact info@interRAI.org or an interRAI representative in your country.
How Systems Develop
A fully realized interRAI assessment "system" consists of:
- A data collection form
- A user manual
- Clinical Assessment Protocols, or CAPs
- Status and outcome measures
Because each of the instruments in the interRAI family is in a different stage of maturity, not every instrument system in the suite necessarily contains all of these features. However, every interRAI system goes through a careful, scientifically based development process to develop instruments and decision support measures. These steps are summarized below. We invite you to visit our Bibliography for abstracts and links to published scientific articles and reports.
Consulting with Front-Line Clinicians and Experts
Each interRAI system begins with conversations about the key clinical issues that should be assessed for a given population. Many points of view, including those of policymakers, advocates, consumers, and purchasers, are sought out to ensure that the information collected on a given instrument has utility for as many audiences as possible, while keeping the size of the instrument within bounds for everyday use.
interRAI development teams carry out extensive trials to ensure that published versions of each instrument are valid and reliable. In addition, clinical trials, studies of clinical acceptability, and longitudinal studies of care outcomes are done to test the instruments in real-life settings. Only after such work is done is the instrument considered ready for implementation in everyday clinical process. This judgment is made by the interRAI Systems and Instrument Development Committee under the leadership of John Morris.
Developing Companion Applications
interRAI research teams develop a variety of other evidence-informed applications, such as telephone screeners, quality indicators, and case-mix systems, using data generated from a given instrument. Turning data into information renders it useful to a variety of audiences, including regulators, payers, and policymakers.
Creating Clinical Assessment Protocols
A key aspect of interRAI assessment systems is written material designed to assist those involved in care planning to consider major issues triggered by the assessment. Typically these are referred to as “clinical assessment protocols,” or CAPs. Each assessment protocol has been produced by a team of expert authors, drawing on empirically tested strategies whenever possible. Assessment protocols help the clinician think through what is known about a given issue, how the problem is experienced by the individual, and why it is present. Assessment protocols also examine possible prevention and treatment options, and help the assessor evaluate whether a referral for further evaluation is needed.
Providing Code to Enable Automation
interRAI hosts a “geek squad” that maintains production code for core scales, CAPs, and other standard applications of interRAI data used across our assessment systems. Licensed vendors and licensed users can access the code, written in SAS programming language, on our Web site.
Ongoing Quality Improvement
interRAI has an ongoing commitment to update our products as scientific knowledge changes, as the needs of health care consumers change, and as the health care system itself changes. Each version of a system has a unique number, for example, interRAI HC v.9.x. New versions will contain improvements in item structure, measurement definitions, CAP triggers, etc., identified from previous research and practice.