Effect of the National Resident Assessment Instrument on Selected Health Conditions and Problems
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OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents. DESIGN: Quasi-experimental, pre-/post-design, with assessments at baseline and 6-month follow-up. SAMPLE: Two thousand one hundred twenty-eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation. MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4-level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow-up, limiting the sample to those who could manifest each such change. MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6-month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement. CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result --an increase in baseline prevalence--also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.
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The introduction of the US Resident Assessment Instrument (which requires mandatory monitoring and reporting of hydration risks) reduced dehydration in older adults.
“It was also suggested that the introduction of the US Resident Assessment Instrument (which requires mandatory monitoring and reporting of hydration risks) reduced dehydration in older adults(220, 261).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [261]
The Results and Discussion report that dehydration prevalence fell after RAI implementation among US nursing-home residents, and the authors suggest the RAI contributed while acknowledging other possible causes. The paper describes required resident assessments and guidelines for identifying dehydration risks, but does not establish a requirement to report those risks; its findings also concern nursing-home residents, not older adults generally. (LLM, conf=0.84)
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Research works printed but not linked: 19
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.01.024 · Cited by 516 · see citing works
Selecting target conditions for quality of care improvement in vulnerable older adults
Sloss, E. M., Solomon, D. H., Shekelle, P. G., Young, R. T., Saliba, D., MacLean, C. H., Rubenstein, L. Z., Schnelle, J. F., Kamberg, C. J., & Wenger, N. S. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb04691.x · Cited by 132 · see citing works
Bunn, D., Jimoh, F., Wilsher, S. H., & Hooper, L. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.10.016 · Cited by 115 · see citing works
- Authors
- Fries, B. E., Hawes, C., Morris, J. N., Phillips, C. D., Mor, V., & Park, P. S.
- Affiliations
- University of Michigan (US)
- RTI International (US)
- Brown University (US)
- Corresponding author
- Fries, Brant E.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 1997-08
- Volume
- 45
- Issue
- 8
- Pages
- 994-1001
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2077999912
- Cited by
- 161
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 6 · 2013: 4 · 2012: 4
- FWCI
- 26.04
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- nursing home residents, Minimum Data Set, health status outcomes, dehydration, falls, pressure ulcers, venous leg ulcers, pain, malnutrition, visual impairment, dental status, body mass index, nursing home quality of care
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Pressure Ulcer, Dehydration, Female, Follow-Up Studies, Health, Health Status, Humans, Male, Nursing Homes, Nutrition Disorders, Pain, Patient Care Planning, Tooth Diseases, United States, Varicose Ulcer, Vision Disorders, Cohort Studies, Geriatric Assessment, Body Mass Index, Prevalence, Logistic Models, Outcome Assessment, Health Care, Practice Guidelines as Topic
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