Geriatric assessment in nursing homes in the United States: Impact of a national program

摘要: Ten years ago, Congress mandated use of a standardized, comprehensive functional assesment tool. Has it made any difference in care? Predicated on the notion that multiple chronic illnesses frail elders cannot be treated isolation, geriatric assessment emerged as multidimensional, interdisciplinary diagnostic process designed to assess health and functioning develop plan care effective reducing negative outcomes (Stuck et al., I993; Rubenstein, 1995). Largely originating among British geriatricians, concepts have been adopted United States myriad inpatient outpatient settings over past 15 (Rubenstein 1984; Deyo, 1991). With this background, when National Academy Sciences' Institute Medicine recommended strategies improve quality nursing home States, central these was development resident instrument (Institute Medicine, I986. Following Medicine's recommendation, U.S. comprehensive, tool all facilities component Nursing Home Reform Act I987 (OBRA '87) (U. S. Congress). The Resident Assessment Instrument (RAs) for by homes consists multidimensional known Minimum Data Set (MDS) eighteen problemfocused Protocols (RAPs) Stuck 1993; MDS items cover dimensions ranging from cognition physical function mood well-being, with checklists common diagnoses, symptoms, syndromes. Depending upon responses items, residents are "triggered" into Protocol potentially having related problem, risk factor, or potential improved function. protocols guide facility staff identifying developing plans problems (Morris xIv implemented states early summer 1991.. We summarize here major findings an evaluation impact RAI received residents. Extended description discussion each issue summarized is available elsewhere (Hawes I997; Morris Phillips I997a; Fries Mor I997). METHODS study employed methods described below. Sites samples. Using appropriate statistical (multistage sampling) achieve representative sample, we randomly sampled z54 located forty-two counties in, adjacent to, ten metropolitan areas, different state. These areas were chosen reflect environments differed strategy used reimburse homes, level reimbursement, average levels. Details sampling procedures (Phillips al.,1997a).. In facility, trained research nurses unaffiliated between eight sixteen residents, depending size, total z,ooo all, prior RAi implementation, fall 1990, collected similar follow-up data same six months later. collection involved reviewing medical records (e.g., admission notes, assessments, physician orders, plan), observing speaking resident, interviewing caring completing entire assessment. Between baseline six-month follow-up, recorded discharges sample members hospital other location, result death. tracked residents' decedents' various transitions across through review contacting next kin. …