Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS-HC

Hebrew Rehabilitation Center for Aged, HRCA Research and Training Institute, Boston, Massachusetts 02131, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/1997; 45(8):1017-24. DOI: 10.1111/j.1532-5415.1997.tb02975.x
Source: PubMed


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.

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    • "We have used the comprehensive Resident Assessment Instrument for Home Care (RAI-HC) to evaluate older adults living at home. Several studies have demonstrated the reliability and validity of this instrument (Hirdes et al., 2004; Morris et al., 1997). It is being used in Canada, the United States, and in eleven European countries (Sorbye et al., 2009). "
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    ABSTRACT: The objective of this article is to estimate the time and associated costs of informal caregiving for the elderly with different levels of dementia. In a cross-sectional observational study with 242 subjects, we use the Resident Assessment Instrument Home Care (RAI-HC) to compile information on socio-demographic variables, informal care, comorbidities, hearing and vision function, use of formal support services, use of locomotion aids, and dementia. We construct a multivariable regression model to determine the cost of informal care due dementia. Findings show a positive association of dementia severity and costs of informal care.
    Journal of Promotion Management 07/2015; 21(4):459-474. DOI:10.1080/10496491.2015.1051398 · 0.44 Impact Factor
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    • "In 2002, the Ontario government mandated the use of a standardized assessment tool, the Resident Assessment Instrument for Home Care (RAI-HC) [3], for all adult, non-palliative long-stay clients. The RAI-HC was developed by interRAI (, "
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    ABSTRACT: Background Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client’s home. In this pilot study, we examined the feasibility of sharing data, from the RAI-HC, between care coordinators and service providers. Methods All participants were involved in a one-day training session on the RAI-HC. The care coordinators shared specific outputs from the RAI-HC, including the embedded health index scales, with their contracted physiotherapy and occupational therapy service providers. Two focus groups were held, one with care coordinators (n = 4) and one with contracted service providers (n = 6). They were asked for their opinions on the positive aspects of the project and areas for improvement. Results The focus groups revealed a number of positive outcomes related to the project including the use of a falls prevention brochure and an increased level of communication between professionals. The participants also cited multiple areas for improvement related to data sharing (e.g., time constraints, data being sent in a timely fashion) and to their standard practices in the community (e.g., busy workloads, difficulties in data sharing, duplication of assessments between professionals). Conclusions Home care professionals were able to share select pieces of information generated from the RAI-HC system and this project enhanced the level of communication between the two groups of professionals. However, a single information session was not adequate training for the rehabilitation professionals, who do not use the RAI-HC as part of normal practice. Better education, ongoing support and timely access to the RAI-HC data are some ways to improve the usefulness of this information for busy home care providers.
    BMC Geriatrics 06/2014; 14(1):81. DOI:10.1186/1471-2318-14-81 · 1.68 Impact Factor
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    • "At the beginning of their practices, all of the case managers had to follow the same training on basic case management principles (120 hours over 6 months). The sites had chosen evaluation tools for use by case managers from three tools: GEVA-A (Guide d’EVAluation des besoins des personnes Agées [guide for evaluating the needs of elderly persons]) developed in France; OEMD-SMAF (Outil d’Evaluation MultiDimensionel basé sur le Système de Mesure de l’Autonomie Fonctionnelle [a multidimensional evaluation tool based on the system for measuring functional autonomy]) [23]; and RAI-HC (Resident Assessment Instrument-Home Care) [24]. "
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    ABSTRACT: The case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of case managers and the value in having multidisciplinary case management teams. The objectives were to develop a fuller understanding of the role played by the case manager team and identify the value of inter-professional collaboration in multidisciplinary teams during the implementation of an innovative integrated service in France. We conducted a qualitative study with focus groups comprising 14 multidisciplinary teams for a total of 59 case managers, six months after their recruitment to the MAIA program (Maison Autonomie Integration Alzheimer). Most of the case managers saw themselves as being part of a team of case managers (91.5%). Case management teams help case managers develop a comprehensive understanding of the integration concept, meet the complex needs of elderly people and change their professional practices. Multidisciplinary case management teams add value by helping case managers move from theory to practice, by encouraging them develop a comprehensive clinical vision, and by initiating the interdisciplinary approach. The multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.
    BMC Health Services Research 04/2014; 14(1):159. DOI:10.1186/1472-6963-14-159 · 1.71 Impact Factor
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