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

Abstract

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...

National Trends in Treatment Initiation for Nursing Home Residents With Diabetes Mellitus, 2008 to 2010

“…However, prior studies confirm the validity of Medicare claims and the MDS for identifying diabetes. 15 Second, our study covers only a three-year period. While a longer duration may have been preferable, three years of calendar time is nonetheless sufficient for describing trends.…”

“…Residents were identified as having diabetes if a diagnosis was present on any MDS assessment, which has good validity for identifying diabetes diagnoses in NHs. 15 …”

Metformin Safety Warnings and Diabetes Drug Prescribing Patterns for Older Nursing Home Residents

“…23 The MDS Changes in Health, End-Stage Disease, Signs, and Symptoms (CHESS) Scale was used as a validated measure of overall health stability and frailty, where 0 indicates no health instability/frailty and 5 indicates very high instability/frailty. 24,25 Values of three to five on the CHESS scale were collapsed into a single category representing moderate to very high health instability. 24,25 Concomitant medication use up to 12 months prior to the index date was assessed.…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…The MDS data have been found to be both reliable and valid [132][133][134] and are used for Medicare and Medicaid reimbursement and for monitoring the quality of care provided to nursing home residents. The MDS is an individual level dataset with detailed information about resident physical, psychological and psycho-social functioning, which is considered the best available data for measuring nursing home quality.…”