As part of a quality improvement initiative at the Veterans Affairs Nebraska–Western Iowa Heath Care System, we adapted the MMRI-R for use in surgical populations. We eliminated the single survey item assessing current or recent dehydration because we thought that this question would be difficult to assess and interpret in the preoperative population. We also modified the item probing admission to a nursing home in the past 3 months to capture anyone living in a setting other than independent living. We though this would more expansively capture the range of nonindependent living situations prevalent among surgical populations that might indicate frailty associated risk. The RAI-C questionnaire includes 14 questions assessing 11 variables and 2 statistical interactions with scores ranging from 0 to 81 (eFigure in the Supplement ). The survey is administered by clinical staff based on patient history and report and scored using parameters developed for the MMRI in an MDS sample of nursing home residents.
Pilot testing demonstrated the feasibility of this abbreviated survey. Because most of the questions were already part of standard nursing interviews, it took clinical staff less than 2 minutes to complete and was easily incorporated into the standard intake procedures at surgical clinics. Based on these findings, on July 1, 2011, we began measuring the RAI-C for every patient presenting to outpatient surgery clinics at the Veterans Affairs Nebraska–Western Iowa Health Care System, requiring the score as a precondition for scheduling any elective surgery.
Responses to each item of the RAI-C were recorded along with patient identifiers. As described elsewhere, patients with an RAI-C score of at least 21 were subjected to administrative review aimed at improving perioperative decision making and outcomes.18 (link) In some cases, this administrative review led to repeated calculation of the RAI-C, often informed by more detailed medical histories. As such, the database includes sequential measurements of the RAI-C on some patients, but for the purposes of this analysis, we used the single RAI-C measurement for each patient that was closest to and antecedent from the date of surgery.
Pilot testing demonstrated the feasibility of this abbreviated survey. Because most of the questions were already part of standard nursing interviews, it took clinical staff less than 2 minutes to complete and was easily incorporated into the standard intake procedures at surgical clinics. Based on these findings, on July 1, 2011, we began measuring the RAI-C for every patient presenting to outpatient surgery clinics at the Veterans Affairs Nebraska–Western Iowa Health Care System, requiring the score as a precondition for scheduling any elective surgery.
Responses to each item of the RAI-C were recorded along with patient identifiers. As described elsewhere, patients with an RAI-C score of at least 21 were subjected to administrative review aimed at improving perioperative decision making and outcomes.18 (link) In some cases, this administrative review led to repeated calculation of the RAI-C, often informed by more detailed medical histories. As such, the database includes sequential measurements of the RAI-C on some patients, but for the purposes of this analysis, we used the single RAI-C measurement for each patient that was closest to and antecedent from the date of surgery.
