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Workshop 6:SAT: Assessment and Care of Older People using the Single Assessment Tool
Dr. Natalie Vereker, National Specialist, Services for Older People, HSE Ireland
Linda McDermott-Scales, SAT National Education & Development Manager, Services
for Older People, HSE Ireland
Room -TBC
Workshop objectives
Overview SAT and SAT selection
Overview of SAT- interRAI System & interRAI Applications
Facilitate discussion on the importance of SAT in the provision of older persons care
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Single Assessment Tool (SAT)Recap in brief:
The Single Assessment Tool (SAT) is an IT enabled comprehensive health & social care needs assessment (interRAI System©).
SAT is the new national standard for the assessment of people (primarily for those aged 65 & over) applying for:
Nursing Home Support Scheme (NHSS) Home Supports (Home Care Package Schemes / Home
Help Service)
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The SAT Information System (SATIS)
The SAT & it’s supporting infrastructure the Single Assessment Tool Information System (SATIS) will replace the current paper-based Common Summary Assessment Report (CSAR).
Software operates on Tablet / PC devices.
Two SATIS Applications:
Web Application
Mobile Application
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SAT Selection
In 2010 a multi-agency / multi-disciplinary SAT Working Group was established to select, pilot and recommend a Single Assessment Tool.
interRAI was selected as the most fit for purpose tool for implementation in Ireland.
interRAI assessment tools have been developed by an international network of clinicians, researchers, & service users in over 35 countries.
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SAT Governance
2017- 2019
Roll Out
7 Advisory
Working Groups
SAT National Project
Team
National Director Social Care
CHOs Areas 1 to 9- SAT Implementation Teams Led by CHO Heads
of Social Care
All Areas (Community and Acute Care)
SAT Project Board
Working Groups- SUCAG, CNAD, SATIS, RUGs, Knowledge Transfer, Evaluation, Research.
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What is interRAI? Collaborative network of researchers in over 35 countries Non-profit corporation Key interests
Promoting evidence informed clinical practice/ policy decision-making
Research and quality (e.g. cross-national comparisons) Instrument development Support implementation in other nations
Holds copyright to interRAI assessment instruments Grants royalty-free licenses to governments/care providers in
exchange for data Licenses software vendors around the world www.interrai.org
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Applications of interRAI Data- One take of Information – Many Uses
ASSESSMENT
Care Planning
Screening
QualityResearch
Policy
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Comprehensive AssessmentinterRAI HC & interRAI HC for AC/CU Domains
A. Identification Information
B. Intake/ Initial History
C. Cognition
D. Communication/ Vision
E. Mood/Behaviour
F. Psychosocial Well-being
G. Functional Status
H. Continence
I. Disease Diagnoses
J. Health Conditions
K. Oral/Nutritional Status
L. Skin Condition
M. Medications
N. Treatment/ Procedures
O. Responsibility
P. Social Supports
Q. Environmental Assessment
R. Discharge Potential/ Overall Status
S. Discharge
T. Assessment Information
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Applications of interRAI Data- One Take of Information- Many Uses
ASSESSMENT
Care Planning
Screening
QualityResearch
Policy
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Clinical Assessment Protocols? Decision Making Frameworks
Focus on key issues for the person (needs, strengths, preferences, function & Quality of Life) & on areas that may require further assessment and care planning.
“Triggered” by answers to specific assessment items that aim to: Resolve a problem Reduce the risk of decline Increase the potential for improvement
Provide online evidence-based guidelines & best practice recommendations for further assessment, care planning, facilitates referrals; & provide basis for outcome-based assessment of the person’s response to care or services.
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Clinical Assessment Protocols
FUNCTIONAL PERFORMANCE
1. Physical Activities Promotion2. Instrumental Activities of Daily Living3. Activities of Daily Living4. Home Environment Optimisation5. Admission Risk (Long-Term Residential
Care)6. Physical Restraints
COGNITION/MENTAL HEALTH
7. Cognitive Impairment8. Delirium9. Communication10. Mood11. Behaviour12. Vulnerability
SOCIAL LIFE
13. Leisure and Social Activities14. Family Carer Support15. Social Relationships
CLINICAL ISSUES
16. Falls17. Pain18. Pressure Ulcer19. Cardio-Respiratory Conditions20. Undernutrition21. Dehydration22. Feeding Tube23. Health Promotion24. Appropriate Medications25. Tobacco and Alcohol Use26. Urinary Incontinence/ Continence
Promotion27. Bowel Conditions
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Applications of interRAI Data- One Take of Information- Many Uses
ASSESSMENT
Care Planning
Screening
QualityPolicy
Research
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What is a Screener? Subset of question items from the larger assessment
instrument
Software uses algorithms - these are scientifically derived data “recipes” that stream information from individual questions into different risk scales, etc.
Variety of uses Trigger further assessment
Rule out further assessment
Identify target sub-populations
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Status and Outcome Measures for interRAI HC & interRAI for AC/CU Tools (Scales)
Activities of Daily Living (ADL) Hierarchy Scale
Body Mass Index (BMI)
Cognitive Performance Scale (CPS)
Communication Scale
Changes in Health, End-Stage Disease & Signs & Symptoms (CHESS)
Depression Rating Scale (DRS)
IADL Performance Scale
IADL Capacity Scale
Geriatric Screener
Pain Scale
Pressure Ulcer Rating Scale (PURS)
Method for Assigning Priority Levels (MAPLe)
Resource Utilisation Group (RUG) III
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Method of Assigning Priority Levels (MAPLe)
Decision support tool
Informs the allocation of homecare services & prioritisation of individuals requiring community or facility based services
Identifies individuals at risk of admission to Long Term Care
Assists in the care planning process
Supports the monitoring of clients
Higher scores indicate a higher priority client / caregiver distress
September, 2011
1. Low
2. Mild
3. Moderate
4. High
5. Very High
Information & Referral
Home Care
LTC Facility
Low MAPLe
MAPLeExpected
Service Type
Very High MAPLe
MAPLe
1. Low
2. Mild
3. Moderate
4. High
5. Very High
Expected Service Type
Information & Referral
Home Care
LTC Facility
Applications of interRAI Data- One Take of Information- Many Uses
ASSESSMENT
Care Planning
Screening
QualityPolicy
Research
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Quality of Care Measurements
Quality Indicators (QIs) can provide a measure usable for: Performance appraisal; Comparing programmes (benchmarking);
Monitoring programmes; Quality improvement
interRAI QIs measure multiple dimensions Individual/ aggregated QI Summary Measures
Prevalence and Incidence QIs
All case-mix risk adjusted (except Physical Restraints)
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Quality Indicators- Types Available
1. ADL Improvement
2. ADL Decline
3. Bladder Decline
4. Bladder Improvement
5. Cognitive Improvement
6. Cognitive Decline
7. Communication Improvement
8. Communication Decline
9. Falls
10. IADL Improvement
11. IADL Decline
12. Injuries/ Skin breaks & Burns
13. Mood Improvement
14.Mood Decline
15.Pain & either Meds not Controlling pain or No Meds
16.Pain Improvement
17.Daily Severe Pain
18.Continued Caregiver Distress
19.Alone & Distressed
20.Client no longer going out but used too
21.Not Received Influenza Vaccine
22.Acute Hospital ER/ Care
23.Unintended Weight Loss
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Applications of interRAI Data- One Take of Information- Many Uses
ASSESSMENT
Care Planning
Screening
QualityResearch
Policy
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Applications of interRAI Data- One Take of Information- Many Uses
ASSESSMENT
Care Planning
Screening
QualityResearch
Policy
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SAT Assessment Comprehensive holistic assessment system - places the individual at
the centre (assessment/ care planning processes) to support a capabilities- based approach to care & equitable service provision.
Provides clinicians with additional online Care Planning supports:
CAPs – Decision Support Frameworks e.g. Cognitive Impairment; Mood; Behaviour; Delirium; Social Relationships; Activities, etc.
Status & Outcome measures - e.g. Cognitive Performance Scale; Depression Rating Scale (DRS); IADL Capacity Scale; Activities of Daily Living (ADL) Hierarchy Scale; Communication Scale; Frailty.
SAT does NOT provide automated care rather it generates information to facilitate better informed, and higher quality decision-making .
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SAT Benefits • SAT supports effective care planning with the older person.
• Provides information on unmet needs.
• Supports health professionals by prioritising access to services based on assessed need & facilitates the provision of integrated care.
• High quality and reliable data available which can be easily shared between hospital and community sectors.
• Aggregated data will be available to produce measures of outcome, quality of care and eligibility criteria for access to services.
• SAT will deliver a fully developed, robust, reliable, standardised multi-dimensional assessment system.
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