Functional assessment of nursing home patients. Reliability and relevance

Functional assessment of patients for resource allocation or staffing requires a higher level of interrater reliability than functional assessment in normal clinical settings. Although many functional assessment instruments are available, interrater reliability of these items has frequently not been reported. An assessment instrument based on the Long Term Care Minimum Data Set format was used for 290 patients in six wards in two Veterans Administration nursing homes. Each patient was assessed independently by two nurse caregivers to obtain reliability information. Different reliability measures yielded differing evaluations of the reliability of the instrument. Absolute agreement rates combined with Kendall's tau-b were most useful in deciding on the reliability of items in the instrument.