Second and third generation assessment instruments: the birth of standardization in geriatric care.
The systematic adoption of "second-generation" comprehensive geriatric assessment instruments, initiated with the Minimum Data Set (MDS) implementation in U.S. nursing homes, and continued with the uptake of related MDS instruments internationally, has contributed to the creation of large patient-level data sets. In the present special article, we illustrate the potential of analyses using the MDS data to: (a) identify novel prognostic factors; (b) explore outcomes of interventions in relatively unselected clinical populations; (c) monitor quality of care; and (d) conduct comparisons of case mix, outcomes, and quality of care. To illustrate these applications, we use a sample of elderly patients admitted to home care in 11 European Home Health Agencies that participated in the AgeD in HOme Care (AD-HOC) project, sponsored by the European Union. The participants were assessed by trained staff using the MDS for Home Care, 2.0 version. We argue that the harmonization by InterRAI of the MDS forms for different health settings, referred to as "the third generation of assessment," has produced the first scientific, standardized methodology in the approach to effective geriatric care.
Bernabei
Roberto
R
Centro Medicina dell'Invecchiamento (CEMI), Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Rome, Italy.
Landi
Francesco
F
Onder
Graziano
G
Liperoti
Rosa
R
Gambassi
Giovanni
G
D000203:Activities of Daily Living; D000368:Aged; D015577:Geriatric Assessment / Q000379:methods; D005853:Geriatrics / Q000379:methods / Q000592:standards; D006299:Health Services for the Aged / Q000592:standards*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D011787:Quality of Health Care / Q000592:standards*; D012015:Reference Standards