A COMMITMENT TO CHANGE - REVISION OF HCFAS RAI

OBJECTIVE: To describe the reliability of new assessment items and the ir clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assess ment Instrument (RAI). DESIGN: Independent dual assessment of resident s of nursing facilities by staff nurses using a draft of Version 2.0 o f the minimum data set (MDS). SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states vol unteered to test Version 2.0 of the MDS. MEASUREMENT: The full array o f MDS assessment items included measures in the following areas: Backg round information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and s tructural problems, continence, disease diagnoses, health condition, o ral/nutritional status, dental status, skin condition, activity pursui t patterns, medications, special treatments and procedures, and discha rge potential and overall status. RESULTS: Evaluative data address iss ues of MDS item utility and reliability. For new items, almost all ach ieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training mat erials, even the non-changed items had higher average reliability leve ls. Based on the success of the field test and the positive response o f 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 nec essary. CONCLUSION: Findings support the reliability and clinical util ity of the new and revised assessment items incorporated by HCFA in Ve rsion 2.0 of the MDS.