Phillips C D, Morris J N, Hawes C, Fries B E, Mor V, Nennstiel M, Iannacchione V
Myers Research Institute, Menorah Park Center for the Aging, Beachwood, Ohio 44122-1156, USA.
J Am Geriatr Soc. 1997 Aug;45(8):986-93. doi: 10.1111/j.1532-5415.1997.tb02971.x.
To evaluate the impact of the Resident Assessment Instrument (RAI) on changes in nursing home residents' functional status, cognitive status, and psychosocial well-being.
A quasi-experiment involving the collection of longitudinal data on two cohorts of nursing home residents. One cohort was assessed before the implementation of the RAI, and the other was assessed after the implementation of the new assessment process.
Over 2000 nursing home residents in 267 nursing homes located in 10 geographic areas were assessed during the pre-RAI period. In the post-RAI period, 2000 new residents in 254 of the same facilities were assessed.
RAI implementation began in October 1990 and continued until October 1991. The RAI includes a structured, multidimensional resident assessment and problem identification system designed to form the basis for residents' care plans.
All residents were assessed at baseline and at 6 months using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS) and its protocols. All data were collected by research nurses employed and trained by the research team.
Implementation of the RAI significantly reduced the rate of decline in seven of the nine outcomes under consideration. Reductions in improvement were also observed in all outcomes. In activities of daily living, social engagement, and cognitive function, the reduced decline far outweighed any reductions in improvement. In mood problems, problem behaviors, and understanding others, however, reductions in improvement were greater than any reductions in decline. Changes in the rates of decline and improvement were not uniform across all residents.
The RAI may have improved the quality of care of nursing home residents by reducing overall rates of decline in important areas of resident function. However, this innovation may have generated trade-offs in that it may have reduced improvement rates in some areas of function. The system's implementation also seems to have focused staff's attention on the needs and strengths of specific subpopulations of residents. Revisions of the RAI must assist staff in generalizing their efforts to all residents and to increasing improvement rates, especially in areas related to mood and behavior.
评估居民评估工具（RAI）对疗养院居民功能状态、认知状态和心理社会幸福感变化的影响。
一项准实验，涉及收集两组疗养院居民的纵向数据。一组在RAI实施前进行评估，另一组在新评估流程实施后进行评估。
在RAI实施前阶段，对位于10个地理区域的267家疗养院的2000多名疗养院居民进行了评估。在RAI实施后阶段，对同一设施中254家的2000名新居民进行了评估。
RAI的实施始于1990年10月，持续至1991年10月。RAI包括一个结构化的、多维度的居民评估和问题识别系统，旨在为居民护理计划奠定基础。
所有居民在基线时和6个月时使用疗养院居民评估和护理筛查最小数据集（MDS）及其方案进行评估。所有数据均由研究团队雇佣和培训的研究护士收集。
RAI的实施显著降低了所考虑的九个结果中七个结果的下降率。在所有结果中也观察到改善率的降低。在日常生活活动、社交参与和认知功能方面，下降率的降低远远超过改善率的任何降低。然而，在情绪问题、问题行为和理解他人方面，改善率的降低大于下降率的任何降低。下降率和改善率的变化在所有居民中并不一致。
RAI可能通过降低居民功能重要领域的总体下降率提高了疗养院居民的护理质量。然而，这项创新可能产生了权衡，因为它可能降低了某些功能领域的改善率。该系统的实施似乎也使工作人员将注意力集中在特定居民亚群体的需求和优势上。RAI的修订必须帮助工作人员将他们的努力推广到所有居民，并提高改善率，特别是在与情绪和行为相关的领域。
