A Commitment to Change: Revision of HCFA's RAI

Morris, John N.; Nonemaker, Sue; Murphy, Katharine M.; Hawes, Catherine; Fries, Brant E.; Mor, Vincent; Phillips, Charles D.

doi:10.1111/j.1532-5415.1997.tb02974.x

Cited by 213 publications

(128 citation statements)

References 6 publications

(8 reference statements)

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“…Since the MDS administration is much more extensive than the FIM, assessment burden may result in assessments being completed quickly instead of accurately, which further introduces rater error. The MDS items have been shown to have high interrater reliability with walking items (weighted κ = 0.89-0.92) [25], overall ADL items (r = 0.99), and cognition items (r = 0.80) [26]. However, few MDS studies focused on physical functioning and cognition/communication domains and information regarding the psychometrics of these two sections is insufficient.…”

Section: Discussionmentioning

confidence: 99%

Validation of FIM-MDS crosswalk conversion algorithm

Wang

Byers²,

Velozo³

2008

JRRD

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Abstract-In this study, we performed a validation analysis of a crosswalk that converts Functional Independence Measure (FIM) scores to Minimum Data Set (MDS) scores and vice versa in order to achieve score compatibility. Data from 2,130 patients were obtained from the Department of Veteran Affairs' Austin Automation Center. The conversion algorithm was tested at the (1) individual patient level, (2) classification level, and (3) facility level. The validity testing resulted in mixed findings. The mean MDS-derived FIM (FIMc) scores were within 1.3 and 0.1 points of the mean actual FIM (FIMa) scores for the motor and cognition scales, respectively. Kappa statistics demonstrated a fair to substantial (0.37-0.66) strength of agreement between functional-related group classifications generated from the FIMa and FIMc scores. Four of the five facilities had an average point difference of 2.4 between the mean FIMa and FIMc scores. While the sample distributions were similar, individual score comparisons fell short of expectations. Only 37% to 67% of the FIMc scores were within 5 points of the FIMa scores. The crosswalk algorithm demonstrated a convenient way to achieve score comparisons across different rehabilitation settings. However, the effectiveness of a single measure or of crosswalk conversions may ultimately depend on the quality of the data.

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Section: Discussionmentioning

confidence: 99%

Validation of FIM-MDS crosswalk conversion algorithm

Wang

Byers²,

Velozo³

2008

JRRD

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“…Two data sources from the state of Michigan were used to identify and describe the study population: (1) The Minimum Data Set-Nursing Home (MDS-NH) Version 2.0 for the institutionalized sample [9][10][11][12] and (2) the MDS-Home Care (MDS-HC) for the community-based sample. 13 The MDS is mandated for use in all nursing homes (MDS-NH) nationwide.…”

Section: Data Sourcesmentioning

confidence: 99%

“…13 The MDS is mandated for use in all nursing homes (MDS-NH) nationwide. [9][10][11][12] As well, Michigan has mandated the use of a compatible assessment system, the MDS-HC, 13 for use in its Michigan Choice Waiver for the Elderly and Disabled program. The waiver program provides a wide range of home care agency-based services to persons who would otherwise be eligible for nursing home care.…”

Section: Data Sourcesmentioning

confidence: 99%

“…[9][10][11][12][13] The MDS is a standardized, comprehensive, assessment instrument that collects data on a broad range issues pertinent to end-of-life care including: burdensome symptoms, advance directives, health service utilization, and treatments. In Michigan, the MDS is mandated for use in all nursing homes [9][10][11][12] as well as by the state's publicly funded home care services, 13 providing a unique opportunity to describe terminal care in these two settings.…”

Section: Introduction Bmentioning

confidence: 99%

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Terminal Care for Persons with Advanced Dementia in the Nursing Home and Home Care Settings

Mitchell

Morris

Park

et al. 2004

Journal of Palliative Medicine

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“…The RAI/MDS focuses on patients' functional capacity, resources and needs, is internationally established, valid and reliable (29) and provides a comprehensive assessment of older patients receiving health care (30,31). Selected items from this baseline database of patients' characteristics were extracted for the present study: age, gender, cognitive and functional capacity, medical diagnosis and drug consumption.…”

Section: Data Collectionmentioning

confidence: 99%

Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity

Mamhidir

Wimo

Kihlgren

2012

The Journal of nutrition, health and aging

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Objectives:The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period. Methods: A crosssectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population. Results: The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis. Conclusion: Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations. Key words:Nursing home, dementia, cognitive impairment, referrals, emergency department. 891The Journal of Nutrition, Health & Aging© Volume 16, Number 10, 2012 Received November 25, 2011 Accepted for publication January 19, 2012 07 MAMHIDIR/p/c_04 LORD_c 04/12/12 10:31 Page891 (17), the mean number of prescribed drugs was 10.3 per patient. The proportion of individuals prescribed psychotropic drugs was 80% in NHs and 85% in special care units for dementia. According to Olsson et al. (17), anticholinergic drugs were prescribed for approximately 20% of all NH patients and a high rate of psychotropic drug use (>=80%) was reported.Dementia is becoming a greater problem in health care globally (18), due to an increase in the number of people affected. In Sweden, the number of people suffering from dementia increased from 133, 000 to 148, 000 between 2000 and 2008 (14). Disorders such as dementia that cause cognitive impairment are common in long term institutional care. Mamhidir et al. (19) found that cognitive impairment was present in 67% of NH patients and Nordberg et al. (20) reported 62%. Such patients often exhibit symptoms that are difficult to interpret. Although they have the same illnesses as younger patients, their symptoms differ as they...

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A Commitment to Change: Revision of HCFA's RAI

Abstract: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.

Cited by 213 publications

References 6 publications

Validation of FIM-MDS crosswalk conversion algorithm

Validation of FIM-MDS crosswalk conversion algorithm

Terminal Care for Persons with Advanced Dementia in the Nursing Home and Home Care Settings

Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity

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