A new assessment for elders admitted to acute care: Reliability of the MDS-AC

Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically e valuated using the Minimum Data Set for Acute Care (MDS-AC). Content was de veloped by literature review and consultation with professionals working in acute areas. Dual independent assessments were conducted on hospital in-pa tients in 4 countries. Inter-assessor reliability coefficients were calcula ted for each item. Kappa was calculated for all binary and multi-level nomi nal variables. Quadratically weighted Kappa was estimated for all ordinal m ulti-level variables. Where one level of the variable contained 90% or more of the subjects, total observed agreement is reported. Separate reliabilit y estimates were calculated for pre-hospitalization and inpatient items. Su bjects had a mean age of 78. Completion of pre-hospitalization and hospital period assessment (combined) required 20 and 30 minutes. Excluding items f or which 90% or more of subjects were classified into a single scoring leve l, average inter-assessor reliability coefficient for the pre-hospital peri od items was 0.57 and for to hospital 0.58. Overall exact agreement was 83% for prehospitalization assessment items, and 79% for the in-hospital items . The reliability achieved in the highly unstable situation of the acute ad mission phase is sufficient for use in clinical care and research. Differen ces in pre-hospital and admission status necessary for case-mix adjusted co mparison of outcomes were illustrated. Development of a means for systemati cally comparing changes in older people during the course of illness is of increasing importance when addressing questions of the appropriate and inap propriate use of medical technology. (C) 2001, Editrice Kurtis.