Editorial: Resident Assessment Instruments: Their Use for Health Care Planning and Research
Aging populations, especially in industrialized nations, place increased demands on health care services. Because of their diverse and complex health problems, older persons consume a greater proportion of health care services than the young. Rising health care costs attributed largely to older persons, coupled with financial constraints, have become a major focus of concern in Canada and other countries. The challenge for policy makers, regulatory agencies and service providers in resolving this concern is to reduce costs of health care to older persons while maintaining its quality. The U.S. Institute of Medicine has defined quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Lohr & Walker, 1990). In 1983 the U.S. Congress asked the Institute of Medicine to examine that country's nursing home system, a major contributor to health care costs, and recommend ways to improve it. One of the Institute's central recommendations was the development of a uniform, comprehensive resident assessment. The articles in this issue illustrate the use of the Resident Assessment Instrument (RAI), which grew out of that recommendation, to address quality of care for older persons. The RAI was developed by the Health Care Financing Administration (HCFA), the federal agency responsible for setting nursing home standards. The U.S. Congress gave HCFA authority to develop the RAI and regulations governing its use in the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). HCFA's new assessment and regulations were implemented in Spring 1991 and now apply to more than 90 per cent of all nursing homes in the United States. The nursing home version of the RAI was developed by a multidisciplinary team of health professionals. It includes three key components. The first is a set of assessment items that provide a comprehensive profile of each resident. This component, called the Minimum Data Set (MDS), covers various domains which include: background and customary routines, communication/hearing patterns, physical functioning and structural problems, mood and behaviour patterns, disease diagnosis, oral/nutritional status, skin condition, special treatments and procedures, cognitive patterns, vision patterns, continence, activity pursuit patterns, health conditions, oral/dental status and medication use. The second