title: Validity of the interRAI Acute Care based on test content: a multi-center study.
abstract: OBJECTIVE
  The MDS inter- RAI Acute Care is a comprehensive geriatric assessment tool for hospitalized older persons. The aim was to examine its validity based on test content by use in daily clinical practice.
  
  
  METHODS
  Clinical staff of multiple disciplines assessed 256 older persons (83.2±5.2 years; 60% female) in a cross-sectional multicenter study in nine acute hospitals. Test content was empirically tested by frequency distribution of clinical deficits, missing, and invalid data. Item relevance was quantified by the content validity index (CVI) and modified kappa statistics (κ*) based on assessors' judgment.
  
  
  RESULTS
  Clinical deficits exceeded 30% in the majority of items (67%) across all assessment periods. Mean missing data for premorbid, admission, day-14 and discharge assessments were 9.7%, 5.3%, 29.3% and 13.7%, respectively. Invalid scores ranged from 3.9% to 26.7%. Of the 98 items, 82 had excellent CVI (≥0.78). Item relevance was excellent for 82 (κ*≥0.75), good for 9 (0.60≤κ*≤0.74) and fair for 3 items (0.40≤κ*<0.60). Item revision may optimize clinical relevance: removing 4 items with poor relevance would increase the overall CVI from 0.89 to 0.91, meeting the standard of excellent content validity (CVIaverage≥0.90).
  
  
  CONCLUSIONS
  Although the frequency distribution provides evidence that item selection of the interRAI Acute Care is appropriate for the targeted population, its use in a clinical context reveals a substantial number of missing and invalid data. To improve validity, training should pay specific attention to items with low compliance and invalid records. Software applications should also be designed to improve data quality.
authors.affiliation: Center for Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35 PB 7001, 3000 Leuven, Belgium.
authors.forename: Nathalie I H
authors.initials: NI
authors.lastname: Wellens
authors.forename: Mieke
authors.initials: M
authors.lastname: Deschodt
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.forename: Len
authors.initials: L
authors.lastname: Gray
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006694:Holistic Health; D006761:Hospitals; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care / Q000379:methods*