Accuracy, validity and reliability in assessment and in evaluation of services for older people: the role of the interRAI MDS assessment system

Abstract

In this issue of Age and Ageing, Jónsson reports how co-morbidity and functional limitations in older people in acute hospital care are under-reported in the acute medical admission notes when compared with assessment using the interRAI Acute Care instrument [1]. The implications are that problems may be discovered later in the in-patient stay delaying discharge or not addressed at all resulting in greater problems for the older person at home after discharge and possibly re-admission or admission to long-term care. In the UK, there is the particular challenge of Payment by Results, which is introducing tariff-based payments for acute hospital care. The tariffs are set on a primarily diagnosis- and procedure-based system, which does not yet account for increased lengths of stay for people with physical disability [2], those with a ‘high level of need’—in the UK, their number is predicted to increase 54% by 2025 as the population ages [3]. If the acute medical records of these mainly older in-patients are incomplete, then clinical coding cannot even begin to support a re-imbursement system.