Real-world evaluation of the resident assessment instrument-mental health assessment system

Abstract

Objective: We evaluated the Resident Assessment Instrument-Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality. Method: Structured interviews with program staff were used for preliminary informationgathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality. Results: There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system's ability to support outcome monitoring. There was variability in implementation and performance across clinical programs. Conclusions: This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to shortterm, highly specialized services. In particular, the suitability of the RAI-MH for hospitalbased addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.