A Commitment to Change: Revision of HCFA's RAI

TLDR

The study aims to evaluate the reliability and clinical usefulness of new and revised items in Version 2.0 of the Resident Assessment Instrument, as judged by experienced nurse assessors during a field test. Independent dual assessments were performed by staff nurses on 187 randomly selected residents from 21 nursing homes across seven states, using a draft of Version 2.0 of the MDS, which covered a comprehensive array of health and functional domains. The field test showed that almost all new items achieved high weighted Kappa inter‑rater reliability, revised items outperformed earlier ones, and even unchanged items improved with updated training; consequently, Version 2.0 was adopted and HCFA began a long‑range update process.

Abstract

OBJECTIVE : To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI). DESIGN : Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS). SETTING AND PARTICIPANTS : A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS. MEASUREMENT : The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well‐being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status. RESULTS : Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high‐weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non‐changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long‐range process to update further the RAI when necessary. CONCLUSION : Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.