Authors: G I Carpenter G F Teare K Steel K Berg K Murphy J Bjornson P V Jonsson J P Hirdes
Publish Date: 2014/06/29
Volume: 13, Issue: 4, Pages: 316-330
Abstract
Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care We report the development of a new assessment instrument and illustrate how differences between prehospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care MDSAC Content was developed by literature review and consultation with professionals working in acute areas Dual independent assessments were conducted on hospital inpatients in 4 countries Interassessor reliability coefficients were calculated for each item Kappa was calculated for all binary and multilevel nominal variables Quadratically weighted Kappa was estimated for all ordinal multilevel variables Where one level of the variable contained 90 or more of the subjects total observed agreement is reported Separate reliability estimates were calculated for prehospitalization and inpatient items Subjects hadamean age of 78 Completion of prehospitalization and hospital period assessment combined required 20 and 30 minutes Excluding items for which 90 or more of subjects were classified into a single scoring level average interassessor reliability coefficient for the prehospital period items was 057 and for in hospital 058 Overall exact agreement was 83 for prehospitalization assessment items and 79 for the inhospital items The reliability achieved in the highly unstable situation of the acute admission phase is sufficient for use in clinical care and research Differences in prehospital and admission status necessary for casemix adjusted comparison of outcomes were illustrated Development of a means for systematically comparing changes in older people during the course of illness is of increasing importance when addressing questions of the appropriate and inappropriate use of medical technology
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