Critical review of resident assessment protocols.
OBJECTIVE
To evaluate the quality of all 18 federally mandated Resident Assessment Protocols (RAPs) by measuring their adherence to established criteria for clinical practice guidelines (CPGs).


METHODS
Analytical evaluation.


METHODS
United States nursing homes.


METHODS
Eighteen federally mandated RAPs.


METHODS
Each RAP was evaluated using review criteria based on the 1992 Institute of Medicine criteria for measuring the quality of clinical practice guidelines. Criteria included measurements of RAP validity, reliability/reproducibility, clinical applicability, clinical flexibility, clarity/format, scheduled review, expertise needed to complete, multidisciplinary process, and resources needed to complete. Two reviewers, each a geriatrician with expertise in nursing home medicine, evaluated each RAP on the degree of compliance with each criterion using a 2-point scale for each criterion.


RESULTS
Overall, no individual RAP met all of the review criteria. The Urinary Incontinence RAP best approximated all the review criteria. The Pressure Ulcer RAP received the lowest score. Notable deficiencies in most of the RAPs included poor validity, documentation, reliability, clinical flexibility, and clinical applicability.


CONCLUSIONS
The RAPs synthesize large amounts of information into key points and recommendations. Nevertheless, RAPs perform poorly when held to formal standards expected for CPGs. Based on these findings, the authors and a technical expert panel convened by the Agency for Health Care Research and Quality generated recommendations that might improve the use and quality of future RAPs.
Dosa
David
D
Quality Partners of Rhode Island, Providence, Rhode Island, USA. ddosa@lifespan.org
Bowers
Barbara
B
Gifford
David R
DR