Research In Progress

The following is an incomplete list of projects that interRAI Canada fellows are involved with

Ensuring uptake of research, evidence, and knowledge by all (EUREKA)

In 2005 the Ontario Ministry of Health mandated the use of the Resident Assessment Instrument Mental Health (RAI-MH) for all patients admitted to adult mental heal beds in Ontario. The RAI-MH is designed to support care planning, outcome measurement, quality improvement and case mix based funding applications. This project aims to develop a "best practice" summary for the RAI-MH that clinicians find useful for treatment and discharge planning. To achieve this, we will hold a three day workshop with stakeholders from at least 10 inpatient mental health settings in Ontario who are familiar with the RAI-MH. The stakeholders will be RAI-MH Coordinators from each hospital. The RAI Coordinators are usually clinicians and health information management professionals who responsible for all education and training related to completion of the RAI-MH. As such, they are the people who know the most about the RAI-MH in their organization including its use by various stakeholders within their organizations. In this workshop, we will engage the stakeholders in discussion about the practical needs facing clinicians and decision makers to identify opportunities where information from the RAI-MH could be leveraged to meet these needs. The end result of this meeting will be a prototype clinical summary based on the RAI-MH that could then be pilot tested in each stakeholders' organization.

Perlman, C., Martin, L., & Bieling, P. Ensuring Uptake of Research, Evidence, and Knowledge by All (EUREKA) (2011-2012). CIHR Meetings, Planning and Dissemination Grant: Planning Grants ($19,757).

Innovations in Data, Evidence and Applications for Persons with Neurological Conditions

Neurological diseases account for about 6% of the global burden of disease, and their importance will continue to rise with the aging of populations around the world. Persons with neurological conditions are, at least for some diagnoses, likely to be heavier users of the health care system than others of their own age. Moreover, conditions that occur earlier in the life course are associated with longer term use of services over the life course. For example, the majority of Canadians with multiple sclerosis who use hospital services are in the 40- 59 year age group. For those with epilepsy, 55 percent of hospital users are under 40 years of age. In addition, many persons with neurological conditions will use services from across the continuum of care. The use of services and the burden on informal caregivers is likely to increase as the severity of symptoms associated with the neurological conditions increases. This suggests that any effort to understand populations affected by neurological conditions must take a cross-sectoral approach to examining health service utilization, and it must also consider formal and informal sources of support.

The Innovations in Data, Evidence and Applications for Persons with Neurological Conditions (ideas PNC) project will use data from the interRAI suite of assessment instruments (and establish linkages with other appropriate administrative data sources where available) to help improve health services and care for adults living with neurological conditions in Canada. The overall objective of project is to identify opportunities to improve the quality of life of and quality of services offered to persons with neurological conditions and their caregivers based on evidence available from the application of interRAI assessment instruments across the continuum of care in Canada. The activities we will undertake to meet the objectives include: (1) systematic reviews on caregiving, best practices for care planning and quality measures in services targeting persons with Alzheimer's disease and other dementia, epilepsy, multiple sclerosis, Parkinson's disease, traumatic brain injury, spinal cord injury, ALS, Huntington's disease, cerebral palsy, and muscular dystrophy; (2) analysis of available databases obtained from the implementation of interRAI assessment instruments in home care, continuing care facilities, and inpatient psychiatry in five Canadian provinces and territories; and (3) use of data sets linked to the interRAI data to examine resource utilization, medication use, and access to rehabilitation among persons with neurological conditions.

Hirdes, J.P., Maxwell, C.J., Jetter, N. (Co-PIs), Berg, K., Bronskill, S.E., Clarke, B., Colantonia, A., Doran, D., Heckman, G., Hogan, D., Kergoat, M-J., Marrie, R.A., Martin, L., Mitchell, L., Postuma, R., Pringsheim, T., & Zygyn, D. (2010-2013). Innovations in Data, Evidence and Applications for Persons with Neurological Conditions (ideas PNC). Public Health Agency of Canada ($1,470,696).

Multidimensional Assessment of Providers and Systems (MAPS)

The goal of the proposed research program is to deliver a system for tracking developmental program and service performance and outcomes from year to year on a consistent basis. This system, known as the Multidimensional Assessment of Providers and Systems (MAPS), includes an approach and a set of corresponding tools for collecting and aggregating information from developmental services at the provincial level. The goal of developing the MAPS system will be achieved through two related research objectives: (1) to identify key indicators of effectiveness of developmental services in Ontario; and (2) to develop a system of data collection (a toolkit of surveys and tools) that will enable developmental service agencies to use standardized surveys to collect information on indicators of provider and program performance (i.e., quality). In particular, the work will focus on how best to capture information about the outcomes: social inclusion, individual choice and independence.

Ouellette-Kuntz, H., Lysaght, R., Hickey, R., Lunsky, Y., Martin, L., & Cobigo, V. (2010-2013). Multidimensional Assessment of Providers and Systems (MAPS). Ontario Ministry of Community and Social Services ($1.2 million).

Supporting the use of the interRAI ID to understand change through longitudinal studies

As part of its on-going efforts to improve the quality of life and level of independence among persons with intellectual disabilities (ID) in Ontario, the Ministry of Community and Social Services (MCSS) closed the three remaining large scale institutions in the province. This multi-year process began in the spring of 2005 and ended on March 31, 2010. In February 2005, the MCSS provided funding to the ideas for Health research group at the Homewood Research Institute and University of Waterloo to assess all residents in each of the three facilities with the interRAI Intellectual Disability (interRAI ID) assessment instrument. The primary objective of the MCSS study was to collect standardized information on all residents which could be used in addition to information gathered within each of the facilities to inform both individual-level and broader systems planning. As part of this project, the research team also developed and reported on a preliminary case-mix system for the developmental sector that gave insight into the resource utilization/needs of persons with ID residing in the institutions.

Martin, L. (2008-2012). Supporting the use of the interRAI ID to understand change through longitudinal studies. Funded by the Policy, Analysis and Research Branch of the Ministry of Community and Social Services ($147,400).

This project represents an extension of the institution-based project and consists of continued use of the interRAI ID to assess a subset of individuals who have moved to the community. Together, these project have resulted in a data set that is the only one of its kind - to the best of our knowledge, research projects related to deinstitutionalization has been limited to data collected at one point in time in institution followed by some sort of follow-up in the community. This dataset includes interRAI ID data collected at up to 4 points in time in the institutions (fewer data points for persons who moved earlier on) and twice in the community, enabling in-depth examination of the process of deinstitutionalization and its impact on the lives of individuals.

Inventory and resource guide development: The assessment and prevention of suicide

Perlman, C., Hirdes, J.P., Martin, L., Neufeld, E., & Goy, M. (2010-2011). Inventory and resource guide development: The assessment and prevention of suicide. Ontario Hospital Association and Canadian Patient Safety Institute ($20,000).

A comprehensive evaluation plan for the Integrated Client Care Project (ICCP)

"A comprehensive evaluation plan for the Integrated Client Care Project (ICCP) - Palliative Care Initiative in Ontario", 2012 - 2014. PI: Hsien Seow, Co-investigators: Kevin Brazil, Jonanthan Sussman, Dawn Guthrie, Trevor Frise Smith, Daria O'Reilly. Institute of Clinical Evaluation Sciences. ($999,113).

Use of third generation comprehensive clinical assessments to improve acute geriatric care

Costa, AP; Heckman, GH; Hirdes, JP; & Tjam, EY. (2012-2013). Use of third generation comprehensive clinical assessments to improve acute geriatric care. CIHR Planning Grants ($25,000)