Effect of the National Resident Assessment Instrument on selected health conditions and problems.[see comment]

TitleEffect of the National Resident Assessment Instrument on selected health conditions and problems.[see comment]
Publication TypeJournal Article
Year of Publication1997
AuthorsFries B.E, Hawes C., Morris J.N, Phillips C.D, Mor V., Park P.S
JournalJournal of the American Geriatrics Society
Date PublishedAug
Accession Number9256854
Keywords*Geriatric Assessment, *Health, *Health Status, *Nursing Homes, Accidental Falls, Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comparative Study, Decubitus Ulcer/ep [Epidemiology], Dehydration/ep [Epidemiology], Female, Follow-Up Studies, Human, Logistic Models, Male, Nutrition Disorders/ep [Epidemiology], Outcome Assessment (Health Care), Pain/ep [Epidemiology], Patient Care Planning, Practice Guidelines, Prevalence, Support, U.S. Gov't, Non-P.H.S., Tooth Diseases/ep [Epidemiology], United States/ep [Epidemiology], Varicose Ulcer/ep [Epidemiology], Vision Disorders/ep [Epidemiology]

OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents. DESIGN: Quasi-experimental, pre-/post-design, with assessments at baseline and 6-month follow-up. SAMPLE: Two thousand one hundred twenty-eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation. MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4-level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow-up, limiting the sample to those who could manifest each such change. MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6-month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement. CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result --an increase in baseline prevalence--also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.

Alternate JournalJ Am Geriatr Soc