Table 5.

Studies of RAI-related processes variables [4,14,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53].

Author	Setting	Sample Size	Data Source	Design	Measures	Main Findings
Hawes, 1997 [33]	SNFs	254 SNFs	2 resident cohorts (>2000); 10 states	Quasi-experimental probability-based sample	Use of physical restraints and indwelling catheters; Use of advanced directives; Resident participation in activities and toileting programs for bowel incontinence	Decreased use of physical restraints and indwelling catheters; Increased use of advanced directives; Increased resident participation in activities and toileting programs for bowel incontinence
Achterberg, 2001 [39]	Dutch NHs	10 NHs; 18 wards	Interviews with residents and staff	Quasi-experimental	Quality of coordination	Improvement in care coordination post RAI implementation
Lee, 2003 [40]	Midwest NHs	3 NHs	Observation, interview, medical record review	Mixed methods	Process based costing of care planning in NHs	Calculating directs costs for care planning is possible. Data collection for costs is based on a process map.
Tauton, 2004 [41]	Midwest NHs	3 NHs	Semi-structured interview, observation, chart audit	Mixed methods/case reports	Care planning process	Facilities differed in their approaches; care linked to other methods of communication and records.
Piven, 2006 [42]	SNFs	2 SNFs; 4 MDS coordinators	Staff interviews with MDS coordinators, administration, nursing social work, activities, rehabilitation, dietary, environmental services	Comparative multiple case study	MDS Coordinators’ patterns of relationships and association with care processes	Positive MDS patterns generated new information flow, good connections, cognitive diversity contributed to positive assessment and care planning. Negative MDS patterns had opposite effect
Bott, 2007 [43]	NHs in Mid-west	Random sample-107 NHs; 437 staff	Staff interviewed: MDS coordinators; assistant coordinators; social services directors, activities directors, dietary directors; other staff (medical records, LVN, therapists, nursing assistants).	Mixed methods	Process-based costing; Indicators for data envelopment analyses (DEA)	2 NHs were most efficient (fewer deficiencies, less time spent in care plan meetings); Less efficient NHs spent 2 to 5 more time in CP meetings and no increase in quality or efficiency. SNFs less likely to be efficient
Colón-Emeric, 2007 [44]	SNFs	4 SNFs; 360 staff	Field observations; shadow encounters; in-depth interviews	Comparative multiple case study	Relationship between staff connections and care planning process	Greater staff connections associated with higher care plan specificity (tailored) and innovation
Adams-Wendling, 2008 [45]	NHs in Mid-west	Purposeful sample of 96 residents’ care plans	Care plan documents	Retrospective case review	Care plan content	Translation issues included: CP length; content (routine practices and redundant interventions); variability in language use; fragmented care plan and poor location
Dellefield, 2008 [46]	AANAC national conference	24 RN MDS coordinators	Focus groups; questionnaires	Mixed methods	Description of MDS Coordinator work in organizational context	Structural, technical, cultural, strategic organizational dimensions influenced work of MDS coordinator
Taunton, 2008 [47]	NHs-Kansas, Missouri	107 random sample NHs; 508 staff members	Telephone interview, OSCAR data	Mixed methods (Correlational model generation-model selection design)	Generate empirically supported model of care planning integrity	Care planning integrity demonstrated through direct relationships with coordination, integration, quality; indirect relationships through integration with IDT team and restorative perspective.
Straker, 2008 [48]	NHs Ohio	997 NHs; 202 respondents	Stratified random sample NHs; random sample staff	Descriptive	Processes used to complete MDS	MDS process is time intensive, involves various staff, requires training, manual is valuable.
Lee, 2009 [49]	NHs-Kansas, Missouri	107 NHs; 437 staff	Staff interviews: MDS coordinators; assistant coordinators; social services directors, activities directors, dietary directors; medical records, LVN, therapists, nursing assistants	Mixed methods-Interviews and regression and DEA analyses	Efficiency of assessment process; Average cost and quality of care plan	NHs used different combinations of staff to complete care plans; Plans/week varied 10 fold; average cost varied 8 fold; 47% had no care plan deficiency in most recent survey.
Kontos, 2009 [50]	NHs in Central Canada	26 personal support workers (PSW)s; 9 supervisors	Focus groups and semi-structured interviews	Focus groups and interviews	Decision-making and care practices of PSWs in relation to RAI/MDS process	Assessment information known by PSWs not captured in RAI/MDS categories or communicated to interdisciplinary team. Factors included lack of access to computerized records, low status, and poor inter-professional collaboration
Lindsay Bratton-Mullins, 2010 [14]	Historic and current nursing text books	7 textbooks	Text in textbooks on care plan education	Phenomenological analysis	Care plan as indicator of change in nursing science instruction	Care plan development used to teach critical thinking skills to RN students
Colon-Emeric, 2010 [51]	SNFs	8 SNFs; 958 staff	Field observations; direct observation; and interviews	Content analysis of in-depth multiple-case study	Purpose and utility of regulations (including RAI/MDS)	Increased mindful behaviors in resident centered SNFs; Reduced mindful behaviors in cost-focused culture due to regulation