DEVELOPMENT OF THE NURSING-HOME RESIDENT ASSESSMENT INSTRUMENT IN THEUSA

Background: the nursing home Resident Assessment Instrument (RAI) incl udes a set of core assessment items, known as the Minimum Data Set (MD S), for assessment and care screening and more detailed Resident Asses sment Protocols in 18 areas that represent common problem areas or ris k factors for nursing home residents. Its primary use is clinical, to assess residents on admission to the nursing home, at least annually t hereafter and on any significant change in status and to develop indiv idualized, 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 th e effects of irs 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 outc omes and reduced hospitalization. Other uses of the RAI data in the US A-including payment using resident classification systems and, with RA I-based outcome-oriented quality indicators, quality assurance activit ies-and the status of RAI use in other countries are also summarized.