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April 18, 2005


U-M researcher leads development of health care standards

ANN ARBOR, Mich.—Researchers, clinicians and policy makers from 26 countries around the globe have worked for three years on a new integrated suite of tools for assessing health care.

Today the international collaborative interRAI, headed by Brant Fries at University of Michigan, is releasing the new assessment tools, designed to help appropriately care for aged and mentally ill people. These tools represent international standards for information to be gathered and used by physicians, nurses, social workers and others in a variety of care settings. They identify patients' strengths and weaknesses, illnesses and capabilities. Such information can play a decisive role in supporting health professionals to develop improved plans of care to address problems and enhance or maintain function.

In addition, the data accumulated from these assessments can help managers and government regulators determine who should be eligible for public programs, evaluate quality of care and calculate appropriate reimbursement for care given.

InterRAI already has collected data in 27 nations. The early data have helped interRAI get a handle on the use of antidepressant drugs, physical restraints that tie an elderly person into a chair or bed, strategies for controlling pain and comparisons of quality of care. These studies have shown that every nation and state provides care that has some significant strengths.

This is no small task—even from state to state in the U.S., there are huge differences in how care is given and what it's called. Getting people from around the world to agree on a way to evaluate the health care given—in places as disparate as China, where a major pilot is about to begin, and Iceland, which has used earlier versions of these assessment tools since 1995—required both diplomacy and massive negotiations on terminology and approach, said Fries, president of the interRAI international collaborative.

The 46 members from North America, Europe, Asia, and the Pacific Rim aimed to develop tools to analyze the health needs of people getting care in a wide variety of settings, including home care, post-acute care, palliative care, nursing facilities, assisted living and mental health.

However, the assessments always focus on the individual person rather than where care is provided, as there are tremendous differences around the world in where care is provided for persons with chronic illness. For example, in Japan, an elderly person might stay in a "hospital" for over a year, while in the United States such long stays would only be in a nursing home or residential care facility. At the same time, an Italian family would care for a similarly ill elderly person at home.

Fries, a professor of health management and policy at U-M's School of Public Health and a faculty member at the U-M Institute of Gerontology, helped found InterRAI after participating in the development of the Resident Assessment Instrument (RAI) for U.S. nursing homes. More than 15 million federally mandated RAI assessments of elderly nursing home residents are performed each year.

Lack of standard measures has been identified by many government commissions and caregivers as a major barrier to integrating the different types of services that people use during their lifetimes.

The new instruments share common core items, definitions and time frames, creating a holistic view of the patients. They provide a common language that the team hopes will encourage and improve transfer of information about individuals across care domains, for example, in an electronic medical record.

The new suite can replace and improve on several interRAI assessment systems actively in use around the world. In the U.S., all nursing homes use the earlier version of the interRAI assessment system and 10 states are using the home care assessment. In several other nations, including most provinces in Canada, interRAI instruments are mandated as a vital part of providing quality care to elderly or disabled persons. The instruments are actively in use as well in Estonia, Finland, Germany, Holland, Israel, Australia and Japan.

With the new suite is a growing set of applications that include measures of the cost, quality and eligibility criteria for care, among other things. Fries anticipates governments will be able to take the measures and build them into person-specific systems for paying for health care.

"A strong point of interRAI instruments has always been their focus on the individual. They help caregivers respond with the right help at the right time, keeping people healthy, independent and vital for as long as possible," said John Morris, the interRAI project leader and co-director of the Research and Training Institute at Hebrew SeniorLife in Boston.  

A non-profit organization, interRAI's provides its assessment systems free to governments and caregivers.


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Brant Fries

Contact: Colleen Newvine
Phone: (734) 647-4411