A commitment to change: revision of HCFA's RAI.[see comment]

TitleA commitment to change: revision of HCFA's RAI.[see comment]
Publication TypeJournal Article
Year of Publication1997
AuthorsMorris J.N, Nonemaker S., Murphy K., Hawes C., Fries B.E, Mor V., Phillips C.
JournalJournal of the American Geriatrics Society
Date PublishedAug
Accession Number9256856
Keywords*Geriatric Assessment, *Health Care Reform, *Nursing Homes, *United States Centers for Medicare and Medicaid Services, Activities of Daily Living, Affect, Aged, Behavior, Cognition, Communication, Diagnosis, Drug Therapy, Health Status, Hearing, Human, Medical History Taking, mental health, Motor Activity, Nursing Assessment, Nutritional Status, Observer Variation, Oral Health, Outcome Assessment (Health Care), Patient Discharge, Reproducibility of Results, Skin/ah [Anatomy & Histology], Support, U.S. Gov't, Non-P.H.S., Therapeutics, United States, Urination, Vision

OBJECTIVE: To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI). DESIGN: Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS). SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS. MEASUREMENT: The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status. RESULTS: Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non-changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long-range process to update further the RAI when necessary. CONCLUSION: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.



Short TitleJournal of the American Geriatrics SocietyJ Am Geriatr Soc
Alternate JournalJ Am Geriatr Soc