The National Nursing Home Resident Assessment Instrument (RAI) is at the core of the group’s work, and was developed in the early 1990s by a research consortium. Using some four million assessments in the U.S. each year, the program includes the Minimum Data Set (MDS), archived at the University of Michigan, which contains over seven million assessments from eleven states. Federal law now requires that the MDS be used in nursing homes.
The program at Hackensack proved to be a "Who’s Who" in end-of-life care, with national experts spotlighting programs to give InterRAI researchers insight on current programs, the kinds of data needed to advance the field, and initiatives underway across the country. Representatives from the Project on Death in America, Americans for Better Care of the Dying, the National Hospice Organization, the Center for Gerontology and Health Care at Brown University, the Robert Wood Johnson Foundation, the American Board of Internal Medicine, the Joint Commission on Accreditation of Healthcare Organizations, and the Health Care Financing Administration described their organizations, projects, and objectives.
Patricia Staten, Associate Director for the JCAHO Department of Standards, described what she called "the other Handbook for Mortals," JCAHO regulations. JCAHO’s new pain management standards will be published in its forthcoming manual. (More information can be found at the JCAHO website).
Sue Nonemaker, a technical advisor from HCFA’s office of clinical standards and quality, described HCPA’s efforts to include palliative and terminal care in the MDS.
InterRAI is establishing many assessment tools to parallel its nursing home work. In addition to developing a palliative care/end-of-life care instrument, the group is developing parallel systems to assess chronic care in acute care settings, mental health care, day care, and post-acute care. Under the leadership of Vincent Mor, Ph.D., InterRAI also promotes the SAGE program, (Systematic Assessment of Geriatric Drug Use via Epidemiology) which enables researchers to blend information about diagnoses and drug use with individual assessment data. The SAGE database, for instance, generated the widely reported study on the failure of nursing homes to adequately treat cancer patients’ pain (Journal of American Medical Association, June 1998).
For more information on InterRAI, contact Knight Steel, M.D., The Homecare Institute, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, phone: 201.883.0667.