A commitment to change: revision of HCFA's RAI.
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).


METHODS
Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS).


METHODS
A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS.


METHODS
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.


CONCLUSIONS
Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.
Morris
J N
JN
Hebrew Rehabilitation Center for Aged, HRCA Research and Training Institute, Boston, Massachusetts 02131, USA.
Nonemaker
S
S
Murphy
K
K
Hawes
C
C
Fries
B E
BE
Mor
V
V
Phillips
C
C
D000203:Activities of Daily Living; D000339:Affect; D000368:Aged; D001519:Behavior; D014487:Centers for Medicare and Medicaid Services, U.S.; D003071:Cognition; D003142:Communication; D003933:Diagnosis; D004358:Drug Therapy; D015577:Geriatric Assessment; D018166:Health Care Reform; D006304:Health Status; D006309:Hearing; D006801:Humans; D008487:Medical History Taking; D008603:Mental Health; D009043:Motor Activity; D009730:Nursing Assessment; D009735:Nursing Homes; D009752:Nutritional Status; D015588:Observer Variation; D009909:Oral Health; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D015203:Reproducibility of Results; D012867:Skin / Q000033:anatomy & histology; D013812:Therapeutics; D014481:United States; D014554:Urination; D014785:Vision, Ocular