Open Access Highly Accessed Research article

Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system

John P Hirdes12*, Gunnar Ljunggren3, John N Morris4, Dinnus HM Frijters5, Harriet Finne Soveri6, Len Gray7, Magnus Björkgren8 and Reudi Gilgen9

Author Affiliations

1 University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada

2 Homewood Research Institute, Guelph, Canada

3 Stockholm County Council, Box 17533, S-11891, Stockholm, Sweden

4 Hebrew Senior Life, 1200 Centre St, Boston, MA 02131, USA

5 PRISMANT, Box 14006, Papendorpseweg 65, 3528 BJ Utrecht, The Netherlands

6 STAKES, Lintulahdenkuja 4, Box 220, FIN-00531, Helsinki, Finland

7 University of Queensland, Academic Unit in Geriatric Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Australia

8 Chydenius Institute, Pitkänsillankatu 1-3, 67100 Kokkola, Finland

9 Stadtspital Waid Zürich, Klinik für Akutgeriatrie, Tièchestraße 99, CH-8037, Zürich, Switzerland

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BMC Health Services Research 2008, 8:277  doi:10.1186/1472-6963-8-277

Published: 30 December 2008



A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument comprises items common to other instruments and specialized items exclusive to that instrument. This study examined the reliability of the items from five instruments supporting home care, long term care, mental health, palliative care and post-acute care.


Paired assessments on 783 individuals across 12 nations were completed within 72 hours of each other by trained assessors who were blinded to the others' assessment. Reliability was tested using weighted kappa coefficients.


The overall kappa mean value for 161 items which are common to 2 or more instruments was 0.75. The kappa mean value for specialized items varied among instruments from 0.63 to 0.73. Over 60% of items scored greater than 0.70.


The vast majority of items exceeded standard cut-offs for acceptable reliability, with only modest variation among instruments. The overall performance of these instruments showed that the interRAI suite has substantial reliability according to conventional cut-offs for interpreting the kappa statistic. The results indicate that interRAI items retain reliability when used across care settings, paving the way for cross domain application of the instruments as part of an integrated health information system.