Reliability of a structured assessment for nonclinicians to detect delirium among new admissions to postacute care.
OBJECTIVE
To evaluate the interrater reliability of a structured delirium assessment method for nonclinician interviewers in elderly patients newly admitted for postacute care.


METHODS
Prospective assessment using dyads of nonclinician raters.


METHODS
Postacute (Medicare) units at 6 skilled nursing facilities.


METHODS
Forty elderly patients newly admitted for postacute care from medical or surgical units at acute care hospitals.


METHODS
Subjects underwent dual delirium assessments within 5 days of admission. The standardized delirium assessment included the Mini-Mental Status Exam and Digit Span to assess overall cognitive function, the Delirium Symptom Interview to elicit specific delirium symptoms, the Memorial Delirium Assessment Scale to measure the severity of delirium, and the Confusion Assessment Method (CAM) to make the diagnosis of delirium. A coding protocol that linked observations to specific coding was used to improve reliability.


RESULTS
The structured delirium assessment process produced very high interobserver agreement for all instruments. Kappa for agreement on delirium diagnosis was 0.95.


CONCLUSIONS
Nonclinician interviewers using a structured delirium assessment achieved reliability that rivaled or exceeded that of trained clinical assessors in other studies. Nonclinicians may offer an effective alternative for the assessment of delirium among postacute patients in skilled nursing facilities.
Simon
Samuel E
SE
Mathematica Policy Research, Cambridge, MA, USA.
Bergmann
Margaret A
MA
Jones
Richard N
RN
Murphy
Katherine M
KM
Orav
E John
EJ
Marcantonio
Edward R
ER
D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007406:Interview, Psychological / Q000379:methods* / Q000592:standards; D008297:Male; D008609:Mental Status Schedule / Q000592:standards*; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015588:Observer Variation; D010343:Patient Admission; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012866:Skilled Nursing Facilities; D019467:Subacute Care