STEP-BY-STEP PROCESS FOR RAI-AC RELIABILITY TRIAL PARTICIPANTS

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STEP-BY-STEP PROCESS FOR RAI-AC RELIABILITY TRIAL
PARTICIPANTS

• Academic Unit in Geriatric Medicine
• The University of Queensland
• School of Medicine
• Princess Alexandra Hospital

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METHODOLOGY

• Assessors
• Select/Train 2 Assessors. Designate as Assessor
  1 and Assessor 2. The protocol stipulates a
  minimum standard of training, of several hours
  duration.
• Ethics approval
• If such assessments are not normal practice at
  your institution, ethics approval may be
  required. The University of Queensland has given
  ethics approval for the entire trial. Please
  advise us if you require a copy of the approval
  documentation.
• A Patient Information Sheet and a Consent Form
  (Appendix 1) (both requirements of the UQ Ethics
  Committee) are enclosed as part of the Protocol
  Pack for Participants). Amend as required for
  your site.

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SAMPLE SELECTION -1

• Cases
• patients aged 70,
• expected LOS at least 48 hours,
• from acute (general or geriatric) medicine or
  orthopaedic wards. (Either or both)
• Random or sequential selection, depending on
  admission rates
• assessment, incl. consent, will take 1 to 2
  hours.
• An assessor could probably do 4-5 cases in any
  one day.
• If admission rates are higher - allowing for,
  say, 70 consent rate then use random sampling
  (e.g. if admission rates are twice daily number
  required, generate a random list of 1s and 2s and
  use to select one of every two presenting cases).
  If admission rates are less than, say, 7 cases
  per day you may choose to select all patients
  admitted/consenting on Monday-Thursday during the
  study period allowing for refusals.

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SAMPLE SELECTION -2

• Cases can be recruited from Geriatric Consulting
  Services. Patients are pre-selected for referral
  to these Services. While not precluding
  participation, patients status must be assessed
  for their first 24 hours in acute care. If
  referral to Consulting Service occurs at
  admission, this would be acceptable.
• Patients who spend several days in ED before
  admission to acute care would not be eligible for
  inclusion in the Trial.

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IDENTIFICATION CODES

• Each Trial site has been allocated an ID Code, as
  follows
• Australia Prof. Len Gray 1
• Australia Dr Michael Brignell 2
• Canada Prof. John Hirdes 3
• Finland Dr Harriet Finne-Soveri 4
• Iceland A/Prof. Palmi Jonsson 5
• Italy Prof. Roberto Bernabei 6
• Mexico Dr Luis Miguel Gutierrez r 7
• Norway Dr Anette Hylen Ranhoff 8
• Spain Dr Sergio Arino Blasco 9
• USA Prof. John Morris 10
• Australia Dr Peter Hunter 11

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CODING ASSESSMENT FORMS

• Code first 20 forms with your ID Code, then a
  consecutive number from 01-20, e.g. for Australia
  (UQ) the coding would be 101 120. These are
  the forms used by the two Assessors (i.e. 10
  each) for the general cases,
• Code next 15 forms with ID Code, then a
  consecutive number from 21-35, followed by the
  letter A. For Australia (UQ) the coding would be
  121A 135A. These are the forms used by
  Assessor 1 for the reliability testing
• Code next 15 forms with ID Code, then a
  consecutive number from 21-35 followed by the
  letter B. For Australia (UQ) the coding would
  be 121B 135B. These are the forms used by
  Assessor 2 for the reliability testing
• Code next 15 forms with ID Code, then a
  consecutive number from 36 - 50, followed by the
  letter A. For Australia (UQ) the coding would be
  136A 150A. These are the forms used by
  Assessor 1 for the validity testing
• Code both the MMSE and the BAI forms with ID
  Code, then consecutive number from 36 - 50
  followed by the letter B. For Australia (UQ) the
  coding would be 136B 150B. These forms are
  used by Assessor 2 for validity testing (i.e.
  there should be an MMSE form coded 136B and a
  Barthel ADL Index form coded 136B, etc.)

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ASSESSMENT - 1

• Both Assessors will conduct an assessment on two
  practice patients and then meet with Site
  Coordinator for First Debriefing. Assessors will
  then commence Trial assessments.
• Record each assessment on the Case
  Assignment/Packing Form.
• Assessor 1 conducts first assessment on 40 of the
  50 selected cases, using the RAI-AC 1.09, 24-48
  hrs after admission for medical treatment or
  72-96 hrs after surgery for orthopaedic patients
  undergoing surgery. If assessment cannot be done
  in the 24-48 hr period and it is done (e.g.)
  48-72 hrs post-admission, data required is still
  the patients status during first 24 hrs
  post-admission.
• The assessment will collect data on patient
  status in the pre-morbid period (i.e. for the 3
  days prior to the event that precipitated the
  current hospital admission) and in the first 24
  hrs following admission. The first 10 cases of
  Assessor 1 will be general cases, i.e. not for
  reliability or validity comparison. They require
  only 1 assessment.

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ASSESSMENT - 2

• Assessor 2 will conduct an assessment on the
  10/50 cases not assessed by Assessor 1 - as for
  Assessor 1, these 10 cases will be general
  cases, i.e. not for reliability or validity
  comparison. They require only 1 assessment.
• For cases 11-25 of Assessor 1, Assessor 2 will
  repeat the RAI-AC assessment within 4 hrs of
  first assessment, if possible, but no later than
  24 hours after the first assessment. This will
  test for inter-rater reliability. There should be
  no discussion or exchange of findings between
  Assessor 1 and Assessor 2 before the second
  assessment is completed.
• For cases 26-40 of Assessor 1, Assessor 2 will
  administer the Barthel ADL Index and the MMSE,
  again within 4 hours of the first assessment, if
  possible, but no later than 24 hours after the
  first assessment. This will test for validity.

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DATA ENTRY/ANALYSIS

• At the end of each week, each Site Coordinator
  will sign off on each assessment completed during
  that week. Assessment forms will then be
  returned to the Senior Investigator (unless that
  is the same person).
• Negotiations are underway to provide software
  that will be available to Trial participants at
  no charge. Alternatively, the data will be
  entered at the University of Queensland.

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RETURN OF FORMS

• At the end of each week, each Assessor will
  return completed assessment forms and a copy of
  the Case Assignment/ Packing Form (with a running
  record of assessments completed, and page 1 of
  the Case Assignment/Packing Form completed) to
  the Site Coordinator. At the end of Week 1, each
  Assessor will also return a completed Hospital
  and Assessor Description form (Appendix 6) to the
  Site Coordinator.
• When all 50 cases have been completed, the
  Assessors will meet with the Site Coordinator to
  complete the Final Briefing.