Implementing the Resident Assessment Instrument: Case Studies of Policymaking for Long-Term Care in Eight Countries


The authors of these case studies describe the use of unique instruments, devised by cross-national collaborators, to array and assess data about persons who receive long-term care and related services in eight countries. These data are of particular importance for policy to improve the quality of care— either voluntarily or through regulation—and to allocate resources more effectively and efficiently across a continuum of services. The instruments also make it possible to compare the cost and quality of long-term care services in different parts of a country and among countries.

The Milbank Memorial Fund, an endowed philanthropic foundation, collaborates with decision makers in the public and private sectors to develop and implement policy that maintains and improves health. The Fund and its constituents among decision makers are eager to learn about the best evidence available to inform choices among alternative policies.

The federal government in the United States commissioned researchers to design and test the instruments that later became the basis of the international project in order to improve formal regulation of the quality of care. Researchers from 22 countries subsequently devised a family of related instruments and helped to adapt them to conditions in particular countries.

Many people participated in writing and reviewing these case studies. They are identified in the Acknowledgments.

Brant Fries requires special recognition. A founder of interRAI, the organization that devised the family of instruments, he was central to planning the case study project and essential to encouraging authors to draft, revise, and revise yet again their manuscripts. Fries and Charles Fahey, a program officer of the Fund, convened a meeting of the authors in Helsinki to review the initial drafts of the cases in the difficult month of September 2001. Fries and Fahey collaborated in writing the introduction to the report, in which they describe the history of the project and the significance of the experience reported in the cases for clinicians and policymakers.

Daniel M. Fox

Samuel L. Milbank