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Development of the Nursing Home Resident Assessment Instrument in the USA
Research Triangle Institute Research Triangle Park, NC, USA
1 Hebrew Rehabilitation Center for the Aged Boston, MA, USA
2 Myers Research Institute, Menorah Park Center for Aging Beachwood, OH, USA
3 Institute of Gerontology, University of Michigan and Veterans Administration Medical Center Ann Arbor, MI, USA
4 Brown University, Center for Gerontology and Health Care Research RI, USA
Address correspondence to: C. Hawes, Research Triangle Institute, 8450 Whispering Pines, Novelty, OH 44072, USA. Fax: (+1) 440 338 1624. E-mail: MCH{at}rti.org
Background: The nursing home Resident Assessment Instrument (RAI) includes a set of core assessment items, known as the Minimum Data Set (MDS), for assessment and care screening and more detailed Resident Assessment Protocols in 18 areas that represent common problem areas or risk factors for nursing home residents. Its primary use is clinical, to assess residents on admission to the nursing home, at least annually thereafter and on any significant change in status and to develop individualized, restorative plans of care.
Aim: To describe the content and development of the RAI, including US testing for MDS item reliability and validity of the RAI, and the results of a 4-year evaluation of the effects of its clinical use.
Conclusions: The evaluation found that implementation of the RAI was associated with significant improvements in a variety of measures of process quality, resident functional outcomes and reduced hospitalization. Other uses of the RAI data in the USA—including payment using resident classification systems and, with RAI-based outcome-oriented quality indicators, quality assurance activities—and the status of RAI use in other countries are also summarized.
Keywords: assessment nursing homes, Minimum Data Set, Resident Assessment Instrument
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