Accuracy of Minimum Data Set in Identifying Residents at Risk for Undernutrition: Oral Intake and Food Complaints

Simmons, Sandra F.; Lim, Betty; Schnelle, John F.

doi:10.1016/s1525-8610(04)70456-9

Cited by 31 publications

(4 citation statements)

References 20 publications

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“…Another study found a discrepancy of around 30% in identifying patients at risk for undernutrition between observations carried out by researchers and records of the evaluation in the patients' medical charts. 18 We found no benchmark study using observations of deliveries to test the accuracy or completeness of medical records.…”

Section: Discussionmentioning

confidence: 99%

How accurate are medical record data in Afghanistan's maternal health facilities? An observational validity study

2013

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ObjectivesImprovement activities, surveillance and research in maternal and neonatal health in Afghanistan rely heavily on medical record data. This study investigates accuracy in delivery care records from three hospitals across workshifts.DesignObservational cross-sectional study.SettingThe study was conducted in one maternity hospital, one general hospital maternity department and one provincial hospital maternity department. Researchers observed vaginal deliveries and recorded observations to later check against data recorded in patient medical records and facility registers.Outcome measuresWe determined the sensitivity, specificity, area under the receiver operator characteristics curves (AUROCs), proportions correctly classified and the tendency to make performance seem better than it actually was.Results600 observations across the three shifts and three hospitals showed high compliance with active management of the third stage of labour, measuring blood loss and uterine contraction at 30 min, cord care, drying and wrapping newborns and Apgar scores and low compliance with monitoring vital signs. Compliance with quality indicators was high and specificity was lower than sensitivity. For adverse outcomes in birth registries, specificity was higher than sensitivity. Overall AUROCs were between 0.5 and 0.6. Of 17 variables that showed biased errors, 12 made performance or outcomes seem better than they were, and five made them look worse (71% vs 29%, p=0.143). Compliance, sensitivity and specificity varied less among the three shifts than among hospitals.ConclusionsMedical record accuracy was generally poor. Errors by clinicians did not appear to follow a pattern of self-enhancement of performance. Because successful improvement activities, surveillance and research in these settings are heavily reliant on collecting accurate data on processes and outcomes of care, substantial improvement is needed in medical record accuracy.

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Section: Discussionmentioning

confidence: 99%

How accurate are medical record data in Afghanistan's maternal health facilities? An observational validity study

2013

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“…While a number of large reliability trials consistently found moderate to excellent levels of inter-rater reliability between research and staff nurses, other studies have found poor correspondence between facility medical records, patient observations and the data in the MDS[14,15,41,42]. Some have noted substantial inter-state and inter-provider [43]variation in data quality and completeness and that facilities which participated in reliability studies differed substantially from those that didn't[15,44].…”

Section: Discussionmentioning

confidence: 99%

Temporal and Geographic variation in the validity and internal consistency of the Nursing Home Resident Assessment Minimum Data Set 2.0

Mor

Intrator

Unruh

et al. 2011

BMC Health Serv Res

101

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BackgroundThe Minimum Data Set (MDS) for nursing home resident assessment has been required in all U.S. nursing homes since 1990 and has been universally computerized since 1998. Initially intended to structure clinical care planning, uses of the MDS expanded to include policy applications such as case-mix reimbursement, quality monitoring and research. The purpose of this paper is to summarize a series of analyses examining the internal consistency and predictive validity of the MDS data as used in the "real world" in all U.S. nursing homes between 1999 and 2007.MethodsWe used person level linked MDS and Medicare denominator and all institutional claim files including inpatient (hospital and skilled nursing facilities) for all Medicare fee-for-service beneficiaries entering U.S. nursing homes during the period 1999 to 2007. We calculated the sensitivity and positive predictive value (PPV) of diagnoses taken from Medicare hospital claims and from the MDS among all new admissions from hospitals to nursing homes and the internal consistency (alpha reliability) of pairs of items within the MDS that logically should be related. We also tested the internal consistency of commonly used MDS based multi-item scales and examined the predictive validity of an MDS based severity measure viz. one year survival. Finally, we examined the correspondence of the MDS discharge record to hospitalizations and deaths seen in Medicare claims, and the completeness of MDS assessments upon skilled nursing facility (SNF) admission.ResultsEach year there were some 800,000 new admissions directly from hospital to US nursing homes and some 900,000 uninterrupted SNF stays. Comparing Medicare enrollment records and claims with MDS records revealed reasonably good correspondence that improved over time (by 2006 only 3% of deaths had no MDS discharge record, only 5% of SNF stays had no MDS, but over 20% of MDS discharges indicating hospitalization had no associated Medicare claim). The PPV and sensitivity levels of Medicare hospital diagnoses and MDS based diagnoses were between .6 and .7 for major diagnoses like CHF, hypertension, diabetes. Internal consistency, as measured by PPV, of the MDS ADL items with other MDS items measuring impairments and symptoms exceeded .9. The Activities of Daily Living (ADL) long form summary scale achieved an alpha inter-consistency level exceeding .85 and multi-item scale alpha levels of .65 were achieved for well being and mood, and .55 for behavior, levels that were sustained even after stratification by ADL and cognition. The Changes in Health, End-stage disease and Symptoms and Signs (CHESS) index, a summary measure of frailty was highly predictive of one year survival.ConclusionThe MDS demonstrates a reasonable level of consistency both in terms of how well MDS diagnoses correspond to hospital discharge diagnoses and in terms of the internal consistency of functioning and behavioral items. The level of alpha reliability and validity demonstrated by the scales suggest that the data can be useful for researc...

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“…Multiple studies reveal that residents with mild-moderate cognitive impairment remain capable of reporting satisfaction and preferences in care. 11 The PI administered the MMSE after obtaining informed consent. Residents that scored >11 were enrolled in the study.…”

Section: Methodsmentioning

confidence: 99%

The Influence of Cognitive Status on Elder Food Choice and Meal Service Satisfaction

Crogan

Short

Dupler

et al. 2012

Am J Alzheimers Dis Other Demen

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Accuracy of Minimum Data Set in Identifying Residents at Risk for Undernutrition: Oral Intake and Food Complaints

Cited by 31 publications

References 20 publications

How accurate are medical record data in Afghanistan's maternal health facilities? An observational validity study

How accurate are medical record data in Afghanistan's maternal health facilities? An observational validity study

Temporal and Geographic variation in the validity and internal consistency of the Nursing Home Resident Assessment Minimum Data Set 2.0

The Influence of Cognitive Status on Elder Food Choice and Meal Service Satisfaction

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