Morris J N, Nonemaker S, Murphy K, Hawes C, Fries B E, Mor V, Phillips C
Hebrew Rehabilitation Center for Aged, HRCA Research and Training Institute, Boston, Massachusetts 02131, USA.
J Am Geriatr Soc. 1997 Aug;45(8):1011-6. doi: 10.1111/j.1532-5415.1997.tb02974.x.
To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI).
Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS).
A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS.
The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status.
Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non-changed items had higher average reliability levels. Based on the success of the field test and the positive response of 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 necessary.
Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.
根据居民评估工具（RAI）2.0版现场测试的结果，描述经验丰富的护士评估人员所判断的新评估项目的可靠性及其临床实用性。
使用最小数据集（MDS）2.0版草案，由注册护士对护理机构的居民进行独立双重评估。
从七个州的21家养老院中随机挑选出187名居民，自愿参与MDS 2.0版的测试。
MDS评估项目的完整列表包括以下方面的测量：背景信息、认知模式、沟通/听力、视力、情绪和行为、心理社会福祉、身体功能和结构问题、大小便失禁、疾病诊断、健康状况、口腔/营养状况、牙齿状况、皮肤状况、活动追求模式、药物治疗、特殊治疗和程序，以及出院可能性和总体状况。
评估数据涉及MDS项目的实用性和可靠性问题。对于新项目，几乎所有项目都达到了相当高的加权卡帕评估者间信度；修订后的项目也超过了早期项目，并且通过更新的培训材料，即使未更改的项目也具有更高的平均信度水平。基于现场测试的成功以及行业的积极反馈，RAI 2.0版已被采用，并且医疗保险和医疗补助服务中心（HCFA）已启动了一个更长期的流程，以便在必要时进一步更新RAI。
研究结果支持医疗保险和医疗补助服务中心（HCFA）在MDS 2.0版中纳入的新的和修订后的评估项目的可靠性和临床实用性。
