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Search Results: 1 - 10 of 229270 matches for " John P. Hirdes "
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Psychometric properties of the interRAI subjective quality of life Instrument for mental health  [PDF]
Tess E. Naus, John P. Hirdes
Health (Health) , 2013, DOI: 10.4236/health.2013.53A084
A new Subjective Quality of Life (SQoL) Instrument for inpatient and community mental health settings was developed by the interRAI research collaborative to support evaluation of quality in mental health settings from the person’s perspective. Ratings of SQoL provide important information about the quality of service and patient experience with the care they receive. This information can help staff to improve approaches to each person’s plan of care in a manner that is meaningful to the individual. This study examined the reliability of the SQoL-MH. 83 inpatients from several clinical departments in a mental health center in South Western Ontario, Canada were randomly assigned to either be interviewed or complete the assessment on his or her own. Reliability was tested using Cronbach’s Alpha. A preliminary factor analysis points to four SQoL-MH subscales with very good internal consistency, ranging from 0.83 to 0.90. Once finalized, the Subjective Quality of Life instrument will be integral to the interRAI suite of instruments used to assess persons with mental health needs. A reliable and valid SQoL-MH instrument will allow mental health service providers to shape or modify care environments in order to enhance quality of life. In addition, the SQoL-MH instrument could also benefit advocacy groups who use reports on quality of life to influence social policy development and funding decisions.
Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care
Dawn M Dalby, John P Hirdes, Brant E Fries
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-7
Abstract: A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI).The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario.Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the ranking of many individual home care providers.In both Canada and the United States efforts are underway to develop systems to assess the quality of health care as a first step to improving services. In the US nursing home sector, the implementation of the Minimum Data Set has been linked to improvements in quality of care [1-4]. Recently, the Centers for Medicare and Medicaid Services (CMS) has developed web pages to give consumers, and the public at large, further information about the quality of nursing homes and
Using machine learning algorithms to guide rehabilitation planning for home care clients
Mu Zhu, Zhanyang Zhang, John P Hirdes, Paul Stolee
BMC Medical Informatics and Decision Making , 2007, DOI: 10.1186/1472-6947-7-41
Abstract: This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of Daily Living Clinical Assessment Protocol (ADLCAP) is used to identify clients with rehabilitation potential. For study purposes, a client is defined as having rehabilitation potential if there was: i) improvement in ADL functioning, or ii) discharge home. SVM and KNN results are compared with those obtained using the ADLCAP. For comparison, the machine learning algorithms use the same functional and health status indicators as the ADLCAP.The KNN and SVM algorithms achieved similar substantially improved performance over the ADLCAP, although false positive and false negative rates were still fairly high (FP > .18, FN > .34 versus FP > .29, FN. > .58 for ADLCAP). Results are used to suggest potential revisions to the ADLCAP.Machine learning algorithms achieved superior predictions than the current protocol. Machine learning results are less readily interpretable, but can also be used to guide development of improved clinical protocols.Targeting older clients for rehabilitation is a clinical challenge and a research priority [1]. For clients being assessed for home care services, the decision to provide rehabilitation (especially physical or occupational therapy) has major implications for the client's future quality of life and independence, as well as major resource implications. There is considerable evidence of the feasibility and effectiveness of rehabilitation in home-based settings [2-5]; there is also evidence that many home care clients who would benefit from rehabilitation services do not receive them [6].Resource constraints will inevitably limit the provision of rehabilitation services, but gaps in service also reflect gaps and shortcomings in the management and use of available health information. More appropriate targeting of rehabilitation therapy could be ach
The Method for Assigning Priority Levels (MAPLe): A new decision-support system for allocating home care resources
John P Hirdes, Jeff W Poss, Nancy Curtin-Telegdi
BMC Medicine , 2008, DOI: 10.1186/1741-7015-6-9
Abstract: Canadian and international data based on the Resident Assessment Instrument – Home Care (RAI-HC) were analyzed to identify predictors for nursing home placement, caregiver distress and for being rated as requiring alternative placement to improve outlook.The Method for Assigning Priority Levels (MAPLe) algorithm was a strong predictor of all three outcomes in the derivation sample. The algorithm was validated with additional data from five other countries, three other provinces, and an Ontario sample obtained after the use of the RAI-HC was mandated.The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services.In Canada, the United States, and internationally, home care is playing an increasingly prominent role in the health care system [1-5], with the aim of reducing costs related to other services, including acute hospitalization and nursing home placement. For example, the Commission on the Future of Home Care in Canada [6] recommended the extension of public funding to cover the cost of four types of home care: post-acute medical care, post-acute rehabilitation, community-based palliative care, and mental health services for clients with behavior-management needs. Although home care accounts only for a small fraction of total expenditures in the Canadian and US health care systems, it has been the sector with the most rapid relative rate of growth in costs [7,8]. In the United States, state 'waiver' programs were introduced with the aim of reducing nursing home utilization among the frail elderly [9]. For example, Michigan's MI-Choice program uses a targeting approach to identify and intervene with those elderly persons at greatest risk of imminent institutionalization in order to prolong their stay in the community.Despite the widespread belief that home care has the potential to reduce expendit
Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region
Andrew P Costa, Jeffrey W Poss, Thomas Peirce, John P Hirdes
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-172
Abstract: Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27?day mean deviation, 99% CI?=?±14.6), psychiatric diagnosis (13?day mean deviation, 99% CI?=?±6.2), abusive behaviours (12?day mean deviation, 99% CI?=?±10.7), and stroke (7?day mean deviation, 99% CI?=?±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment
Perlman Christopher M,Hirdes John P,Barbaree Howard,Fries Brant E
BMC Health Services Research , 2013, DOI: 10.1186/1472-6963-13-15
Abstract: Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.
Use of the interRAI CHESS Scale to Predict Mortality among Persons with Neurological Conditions in Three Care Settings
John P. Hirdes, Jeffrey W. Poss, Lori Mitchell, Lawrence Korngut, George Heckman
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099066
Abstract: Background Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. Methods Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940), complex continuing care hospitals/units (n = 88,721), and nursing homes (n = 185,309) in seven Canadian provinces/territories. Results CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. Conclusions CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada) that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.
Adjustment of nursing home quality indicators
Richard N Jones, John P Hirdes, Jeffrey W Poss, Maureen Kelly, Katharine Berg, Brant E Fries, John N Morris
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-96
Abstract: We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS.More than half of the new QIs achieved a "Moderate" validation level.Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities.In 1986, the Institute of Medicine Committee on Nursing Home Regulation made recommendations to Congress [1] to improve quality of care in nursing homes (NH). One was the systematic collection of standardized data on all NH residents: a minimum data set. Under this mandate, the U.S. Center for Medicare and Medicaid Services (CMS) implemented the Resident Assessment Instrument - Minimum Data Set (MDS). All U.S. long-term care (LTC) facilities must complete standardized MDS assessments of each resident to participate.The MDS includes a clinical assessment of over 400 items covering demographics, medical condition, cognitive, physical, emotional and social functioning, medical diagnoses, therapies, treatments and medication use. The aggregation of individual MDS assessments into archives can be used to generate representative data sets used for prospective payment systems [2], monitoring [3,4] and improving [5-7] quality of care. Inspections were targeted based upon continuous collection of resident characteristics. Quality indicators (QIs), computed from resident-level clinical data, are aggregated to facility level and used for targeting facilities for review [8,9]. Following its implementation in the United States, the MDS has been adopted in a number of other countries. The Canadian Institute for Health Information's (CIHI) Continuing Care Reporting System is the data warehouse for MDS data from eight Canadian provinces/
Sharing clinical information across care settings: the birth of an integrated assessment system
Leonard C Gray, Katherine Berg, Brant E Fries, Jean-Claude Henrard, John P Hirdes, Knight Steel, John N Morris
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-71
Abstract: From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system.The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations.This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.The purpose of health care is to provide person-specific rather than site-specific care [1]. With rare exceptions, the site of care is determined by economic considerations and by the structure and policies of the health and welfare systems of each nation. Thus a country's health care structure may stipulate what services are reimbursed at each level of care and thereby effectively preclude their being provided in other locations. Also the availability of informal support systems or lack of them may result in a given location being the site of care for multiple individuals with quite different needs who therefore require strikingly different services. Nonetheless, although certain diseases, levels of acuity and functional deficits may be more common in one location than another and may be required to justify care in a particular site, the specific needs of each individual must be addressed appropriately regardless of that person's location.Older adults not only use more care, but they receive care in a host of sites, such as hospitals, long term care facilities and even the home. Further, because many older individuals have multiple chronic diseases, t
Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system
John P Hirdes, Gunnar Ljunggren, John N Morris, Dinnus HM Frijters, Harriet Finne Soveri, Len Gray, Magnus Bj?rkgren, Reudi Gilgen
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-277
Abstract: 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.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.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.Population aging and the increased burden of disability in middle and high income nations pose unique challenges to health care systems. The lives of frail elderly individuals and persons with disability are affected by complex interactions of physical, social, medical and environmental factors that necessitate multidisciplinary approaches to care. Services tend to be provided by a variety of health and social service agencies including both community and facility-based settings. For example, persons who are experiencing cognitive loss or decline of functional ability may receive support from home care agencies, supportive housing, rehabilitation services, or nursing homes. Similarly, persons with mental health problems may receive psychiatric services in primary care, community mental health programs, mental health group homes, or in-patient psychiatric units of hospitals. At the end of life, palliative care may be provided by community-based agencies or by residential hospices, but periodic contact with acute hospitals is a
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