Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis

Heckman, George A.; Hirdes, John P.; Hébert, Paul C.; Costa, Andrew P.; Onder, Graziano; Declercq, Anja; Nova, Amanda; Chen, Jonathan; McKelvie, Robert S.

doi:10.1016/j.cjca.2021.07.009

Cited by 7 publications

(5 citation statements)

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“…The use of the assessments enables quality monitoring and can inform decisions about eligibility criteria for access to services. This supports prioritisation of services based on identified needs, targeting priority groups or groups that are at higher relative risk of adverse outcomes [55][56][57][58][59][60][61].…”

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confidence: 62%

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

et al. 2023

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Introduction:In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries:

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confidence: 62%

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

et al. 2023

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“…The interRAI instruments have been shown to have strong reliability and validity, and they include a series of common items that are relevant in all health care settings [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The interRAI PC includes the Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale, which was initially developed with individuals in complex continuing care (CCC) and was found to be a strong predictor of mortality in several studies [27,29,30,[35][36][37][38][39][40]. Its utility is not limited to cancer patients since it was shown to predict mortality in 11 neurological conditions in home care, long-term care and CCC settings [24] and it had better performance than the NYHA functional classification in heart failure [37].…”

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confidence: 99%

The interRAI CHESS scale is comparable to the palliative performance scale in predicting 90-day mortality in a palliative home care population

et al. 2022

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Background Prognostic accuracy is important throughout all stages of the illness trajectory as it has implications for the timing of important conversations and decisions around care. Physicians often tend to over-estimate prognosis and may under-recognize palliative care (PC) needs. It is therefore essential that all relevant stakeholders have as much information available to them as possible when estimating prognosis. Aims The current study examined whether the interRAI Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale is a good predictor of mortality in a known PC population and to see how it compares to the Palliative Performance Scale (PPS) in predicting 90-day mortality. Methods This retrospective cohort study used data from 2011 to 2018 on 80,261 unique individuals receiving palliative home care and assessed with both the interRAI Palliative Care instrument and the PPS. Logistic regression models were used to evaluate the relationship between the main outcome, 90-day mortality and were then replicated for a secondary outcome examining the number of nursing visits. Comparison of survival time was examined using Kaplan-Meier survival curves. Results The CHESS Scale was an acceptable predictor of 90-day mortality (c-statistic = 0.68; p < 0.0001) and was associated with the number of nursing days (c = 0.61; p < 0.0001) and had comparable performance to the PPS (c = 0.69; p < 0.0001). The CHESS Scale performed slightly better than the PPS in predicting 90-day mortality when combined with other interRAI PC items (c = 0.72; p < 0.0001). Conclusion The interRAI CHESS Scale is an additional decision-support tool available to clinicians that can be used alongside the PPS when estimating prognosis. This additional information can assist with the development of care plans, discussions, and referrals to specialist PC teams.

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“…Given the range of care needs present, it is likely the care team will need to be dynamic in membership, with some professionals being consulted for their clinical expertise as needed. For example, given the prevalence of geriatric syndromes and the level of medical instability, cardiorespiratory symptoms and polypharmacy observed in Groups A and B, strong integration with primary care and specialized geriatric services will be necessary [ 35 , 84 , 85 ]. This type of care environment necessitates care team members to have a strong foundation in interprofessional collaboration and communication as well as appropriate tools to support communication within and across organizational boundaries [ 86 , 87 ].…”

Section: Discussionmentioning

confidence: 99%

Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term ‘life care’ at home

Saari,

Giosa,

Holyoke

et al. 2024

PLoS ONE

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Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017–2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group’s dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.

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Assessments of Heart Failure and Frailty-Related Health Instability Provide Complementary and Useful Information for Home-Care Planning and Prognosis

Cited by 7 publications

References 38 publications

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

The interRAI CHESS scale is comparable to the palliative performance scale in predicting 90-day mortality in a palliative home care population

Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term ‘life care’ at home

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