1) The document discusses the history and development of standardized assessment systems called interRAI for evaluating health and social service needs of older adults and persons with disabilities or mental health challenges. 2) It provides an overview of how interRAI assessments are now used across Canada, having been implemented in 10 provinces and territories, with over 8 million assessments completed to date. 3) The document argues that while large amounts of data have been collected, more can be done to develop big ideas and use sound analytic methods to drive improvements in health care quality, such as reducing antipsychotic drug use in nursing homes.

1. www.interrai.org
www.interraicanada.uwaterloo.ca
Using Big Data and Big Ideas to
Improve the Health Care System
John P. Hirdes, PhD FCAHS
Professor
School of Public Health and Health Systems
University of Waterloo
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Twitter: @interRAI_Hirdes

2. www.interrai.org
www.interraicanada.uwaterloo.ca
Butterworths Series on Individual
and Population Aging
Series published between 1986-91
About 15 books published by leading gerontologists of
the time
Gerontology’s “coming of age” in Canada
WF Forbes
-Founding President Canadian Association and Ontario
Gerontology Association
-Vice-President of Gerontological Society of America
-Mentor and PhD Supervisor
Canadian Journal on Aging Special Issue on 25th
Anniversary of series
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3. www.interrai.org
www.interraicanada.uwaterloo.ca
State of the Art in LTC Circa 1986
• No national data for LTC beyond age and sex
• Had to cite small pilot studies for basic clinical information
• Called for implementation of standardized assessment
systems
• But concerned that introduction of computers into LTC may be difficult
• Limited conceptualization of quality measurement
• Focus on survey based methods
• Could not conceive of QI based methods because standardized clinical
information was far-fetched at the time
• Worried about adequacy of evidence for informing
placement into long term care
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4. www.interrai.org
www.interraicanada.uwaterloo.ca
What did we know about disability levels in
Canadian nursing homes in 1986?
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5. www.interrai.org
www.interraicanada.uwaterloo.ca
Implementation & Testing of interRAI Instruments 1996
Solid symbols – mandated or recommended by govt; Hollow symbols – research/evaluation underway
RAI 2.0
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6. www.interrai.org
www.interraicanada.uwaterloo.ca
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RAI 2.0/ interRAI Long Term Care Facilities
RAI-Home Care
RAI-Mental Health
interRAI Community Mental Health
interRAI Emergency Screener for Psychiatry
interRAI Brief Mental Health Screener
interRAI Child/Youth Mental Health
interRAI Intellectual Disability
interRAI Palliative Care
interRAI Acute Care/Emergency Department
interRAI Contact Assessment
interRAI Community Health Assessment
interRAI Subjective Quality of Life
Use of interRAI Instruments in Canada
Solid symbols – mandated or recommended by govt;
Hollow symbols – research/evaluation underway

7. www.interrai.org
www.interraicanada.uwaterloo.ca
National Reporting Systems
• Canadian Institute for Health Information acts as national
data repository
• Continuing Care Reporting System (CCRS)
• Based on RAI 2.0
• Home Care Reporting System (HCRS)
• Based on RAI-HC and interRAI Contact Assessment (incl ED Screener)
• Mental Health Reporting System (OMHRS)
• Based on RAI-MH
• Also supporting interRAI CMH & MH implementation in NFLD and Manitoba
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8. www.interrai.org
www.interraicanada.uwaterloo.ca
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interRAI Canada by the numbers
(Based on CIHI Reporting Systems only to Dec 2014)
• 10 provinces and territories use interRAI instruments (9 mandated, 1 pilot)
• 15 Canadian researchers formally appointed to interRAI international network
• 18 years of data collection to date (no end date planned)
• 45 graduate theses (19 PhD, 26 MSc) completed at UW so far
• 9,000 clinicians in 1,900 organizations use interRAI assessments
• 645,180 new in-person assessments annually
• 2,010,559 Canadians assessed in-person by end of 2014
• 601,610 in nursing homes & CCC hospitals
• 813,342 RAI-HC + 803,431 interRAI CA in home care
• 293,161 in mental health
• 8,729,360 in-person assessments by end of 2014
• 3,992,707 in nursing home & CCC hospitals
• 2,482,972 RAI-HC + 1,293,988 interRAI CA in home care
• 959,698 in mental health
• Over 3 Billion data points available to interRAI Canada researchers so far

9. www.interrai.org
www.interraicanada.uwaterloo.ca
Data data everywhere but not a
thought to think.
Theodore Roszak author of "The Making of a Counter Culture"
Big data are not enough to transform health care.
Big ideas tested with sound analytic methods should be the driving force for
change.
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10. www.interrai.org
www.interraicanada.uwaterloo.ca
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11. www.interrai.org
www.interraicanada.uwaterloo.ca
What Lies Ahead in the
Future of Health Care in
Canada?
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interRAI data on dementia in Canada
2,870,430 assessments of
400,000+ persons with ADRD

12. www.interrai.org
www.interraicanada.uwaterloo.ca
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We can improve the quality of long term care

13. www.interrai.org
www.interraicanada.uwaterloo.ca
yourhealthsystem.cihi.ca
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14. www.interrai.org
www.interraicanada.uwaterloo.ca
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15. www.interrai.org
www.interraicanada.uwaterloo.ca
Rates of Antipsychotic Use Among Nursing Home Residents Age
65+ with Dementia by Mental Health Symptoms and Province
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16. www.interrai.org
www.interraicanada.uwaterloo.ca
Rates of Antipsychotic Use Among Nursing Home Residents Age
65+ with Dementia by Mental Health Symptoms and Care Setting,
Ontario Only
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17. www.interrai.org
www.interraicanada.uwaterloo.ca
Moving from Home Care to Nursing Home
• Consider the LAST RAI-HC assessment compared with the
FIRST RAI 2.0 assessment
• What can we learn about changes with LTC admission?
• How can home care and LTC homes collaborate to manage risk related to the
transition?
• Used sample of 17,949 Ontario HC assessments linked to
first RAI 2.0 assessments
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18. www.interrai.org
www.interraicanada.uwaterloo.ca
Use of Restraints and Antipsychotics in Nursing
Home by CPS Score When Person in Home Care
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19. www.interrai.org
www.interraicanada.uwaterloo.ca
Implications?
• What does this mean for home care
case managers placing a client into
LTC home?
• Whose responsibility is quality of care
after admission?
• Can HC and NH staff collaborate to
improve quality of transitions?
• Can we get different sectors of health
care to work together as a system?
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