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UW-Madison professor aids effort to develop standard healthcare assessments

David R. Zimmerman

David R. Zimmerman (large image)

University of Wisconsin-Madison Industrial and Systems Engineering Professor David Zimmerman is among researchers from 26 countries who on April 18 announced a new standardized suite of instruments that care providers can use to assess patient health regardless of their country or care setting.

Assessment instruments, or comprehensive computerized questionnaires, evaluate the patient's cognition; communication, hearing and vision; physical functioning, health conditions, nutritional status, skin health, and activities, among other information. They enable care teams, which might include nurses, doctors, dieticians, pharmacists, therapists, social workers, the patient and his or her loved ones, to regularly track patient health and plan additional care, if needed.

Such instruments already exist for long-term care facilities, home care, acute or hospital care, post-acute care, palliative care, mental-health care, and assisted living. But researchers in the collaborative, known as InterRAI (for "resident assessment instrument"), studied instruments from each care setting and determined which questions could apply to all care settings and which questions would be setting-specific.

An expert in quality of care for the elderly, Zimmerman — whose Center for Health Systems Research and Analysis developed internationally applied indicators to assess nursing-home quality — was part of a team that reviewed existing instruments for long-term care facilities, post-acute care and assisted living, among others. He and UW-Madison Associate Researcher Lorraine Roberts made recommendations for which items should comprise the core set of questions and which would be specific to a care setting.

"Of current InterRAI instruments, the long-term care facility instrument has the most extensive use, because it's used in every nursing home in the country," says Zimmerman. "In a sense, the long-term care facility instrument became the foundation, so our focus was initially on what we could pull from that to set up a core instrument."

The new suite is the result of three years of research, which included not only international teleconferences with members ranging in geographical location from North America and Europe to Asia and the Pacific Rim, but also several face-to-face meetings.

While each instrument in the suite contains core questions common to all instruments, as well as setting-specific questions, InterRAI members also incorporated provisions that allow for various cultural customs, says Zimmerman. "For example, the extent of informal care-giving may differ from one culture to another, so you might have information that would be useful in a situation where informal care-giving was a more integral part of the care process," he says.

Zimmerman says that InterRAI members agreed that healthcare is a cross-cultural issue that until now, has been largely country-specific. Together, those experts had the resources to make a difference. "Our view was that, while some items need to be more country-specific, it would facilitate cross-cultural assessment and international comparisons if we could avoid country-specific efforts and aim for more international assessment tools and techniques," he says.

The internationally standardized suite opens the door for countries to jointly develop or share clinical-practice guidelines that can be distributed across populations. "It would be easier to export these protocols and disseminate them more widely across the world than if each country had to develop those protocols themselves," says Zimmerman.

In addition, researchers around the world now could use data generated from the questionnaires to study global trends in population health and healthcare, he says.

Perhaps the greatest benefit, however, is for the patients themselves. "Something that has been elusive thus far, especially in the long-term care area, is continuity of care," says Zimmerman. "We have not done a very good job of coordinating — to say nothing of integrating — care across settings in the elderly population. In order to do that, you need a common language and a common set of assessment instruments. This suite can pave the way to providing that foundation."

Based at the University of Michigan, InterRAI provides its assessment systems free of charge to governments and care-giving organizations. For more information, visit