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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    • "The geriatric syndromes of interest to this study were pain, urinary incontinence, disability, falls, dizziness, weight loss, pressure ulcers and delirium[9,12131416]. These were measured using the relevant items of the RAI HC. "
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    ABSTRACT: Background: Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province. Methods: Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC. We assessed 14 different diagnoses and 8 GS (pain, urinary incontinence, falls, disability, dizziness, weight loss, pressure ulcers and delirium). Adjusted mean number of GS per participant was calculated for groups of participants with each disease when occurring alone or with comorbidity. Results: The mean age of the 6903 participants was 82.2±7.4years and 4750 (69%) were women. Participants presented with an average of 2.6 diseases and 2.0 GS: pain (48%), urinary incontinence (47%) and falls (33%) were the most prevalent. Parkinson's disease, cerebrovascular disease and peripheral artery disease were associated with the highest number of GS (2.5, 2.3 and 2.2, respectively). Conversely, hypertension, diabetes, dementia, cancer and thyroid dysfunction were associated with the lowest number of GS (2.0 on average). For 9/14 examined diseases (hypertension, diabetes, dementia, COPD, heart failure, ischemic heart disease, atrial fibrillation, cancer and thyroid dysfunction) the number of GS increased with the degree of comorbidity. Conclusions: Comorbidity and GS are prevalent in older adults receiving home care. Different diseases have a variable impact on occurrence of GS. Comorbidity is not always associated with an increased number of GS.
    Full-text · Article · Nov 2015 · European Journal of Internal Medicine
    • "The MDS is a federally mandated clinical assessment instrument administered to all residents in Medicare-or Medicaid-certified NHs. The MDS includes over 400 data elements related to the physical, mental, and psychosocial health of the residents and is administered to all NH residents within 14 days of admission and at prescribed intervals thereafter (Morris et al. 1997). Many of these items have been previously validated and impart details on the case mix and acuity level of the residents. "
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    ABSTRACT: Using a socio-ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long-term services and supports systems. Data were drawn from the Minimum Data Set, the federal Online Survey, Certification, and Reporting (OSCAR) database, the Area Health Resource File, and the database for all free-standing, certified nursing homes in California (n = 1,127) and Florida (n = 657) from July 2007 to June 2008. Hierarchical generalized linear models were used to examine the impact of facility characteristics on the probability of transitioning to the community. Facility characteristics, including size, occupancy, ownership, average length of stay, proportion of Medicare and Medicaid residents, and the proportion of residents admitted from acute care facilities are associated with discharge but differed by state and whether the discharge occurred after a short or long stay. Short- and long-stay nursing home discharge to the community is affected by resident, facility, and sometimes market characteristics, with Medicaid consistently influencing discharge in both states. © Health Research and Educational Trust.
    No preview · Article · Jul 2015 · Health Services Research
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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.
    Full-text · Article · Jul 2015 · Journal of Promotion Management
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