Morris J N, Fries B E, Steel K, Ikegami N, Bernabei R, Carpenter G I, Gilgen R, Hirdes J P, Topinková E
Hebrew Rehabilitation Center for Aged, HRCA Research and Training Institute, Boston, Massachusetts 02131, USA.
J Am Geriatr Soc. 1997 Aug;45(8):1017-24. doi: 10.1111/j.1532-5415.1997.tb02975.x.
To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS-HC), including reliability estimates, a comparison of MDS-HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS-HC.
Independent, dual assessment of clients of home-care agencies by trained clinicians using a draft of the MDS-HC, with additional descriptive data regarding problem profiles for home care clients.
Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS-HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States.
The array of MDS-HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications.
Forty-seven percent of the functional, health status, social environment, and service items in the MDS-HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS-HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS-HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels.
Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community-based, second-generation problem and care plan-driven assessment instrument, disability assessment can be performed consistently across the world.
描述多维度评估与问题识别系统家庭护理版（MDS - HC）的一项国际试验结果，包括可靠性估计、MDS - HC可靠性与MDS 2.0养老院评估工具中相同项目可靠性的比较，以及使用MDS - HC对家庭护理客户发现的问题类型进行检查。
由经过培训的临床医生使用MDS - HC草案对家庭护理机构的客户进行独立的双重评估，并提供有关家庭护理客户问题概况的额外描述性数据。
来自五个国家的241名随机选择的家庭护理机构客户的双重评估可靠性数据，所有这些客户均自愿测试MDS - HC。还包括来自这些国家的780份家庭护理评估的扩大样本以及来自美国21家养老院的187名接受双重评估的居民。
MDS - HC评估项目包括以下领域的测量：个人项目、认知模式、沟通/听力、视力、情绪与行为、社会功能、非正式支持服务、身体功能、大小便失禁、疾病诊断、健康状况和预防健康措施、营养/水合作用、牙齿状况、皮肤状况、环境评估、服务利用和药物治疗。
MDS - HC中47%的功能、健康状况、社会环境和服务项目取自养老院的MDS 2.0。对于该项目集，估计MDS - HC的平均加权卡帕系数为0.74，MDS 2.0为0.75。同样，在MDS - HC中新引入的项目也具有较高的可靠性值（加权卡帕系数 = 0.70）。描述性结果还对家庭护理客户的问题进行了特征描述，并在认知表现水平内进行了子分析。
研究结果表明，MDS 2.0的核心项目集在社区和养老院环境中同样有效。新项目具有高度可靠性。同时，这些工具可在国际范围内使用，协助并规划广泛服务环境（包括养老院和家庭护理项目）中老年人的护理。借助这种基于社区的、第二代问题和护理计划驱动的评估工具，残疾评估可在全球范围内持续进行。
