How Systems Develop
A comprehensive interRAI assessment instrument consists of:
- A data collection form
- A user manual
- Clinical Assessment Protocols, or CAPs
- Status and outcome measures
interRAI instruments are built on a “core” set of assessment items that are considered 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.
interRAI ISD Committee (Instruments and Systems Development)
All instruments undergo a systematic review process before being approved. This also pertains to an updated version of an existing instrument. This work is done by the interRAI ISD Committee that meets regularly to develop, review, and approve new instruments, 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.
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 processes. This judgment is made by the interRAI ISD Committee.
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.
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 CAPs (Clinical Assessment Protocols or or Collaborative Action Points). 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.
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.