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

摘要: The Minimum Data Set (MDS) for nursing home resident assessment has been required in all U.S. homes since 1990 and universally computerized 1998. Initially intended to structure clinical care planning, uses of the MDS expanded include policy applications such as case-mix reimbursement, quality monitoring research. purpose this paper is summarize a series analyses examining internal consistency predictive validity data used "real world" between 1999 2007. We person level linked Medicare denominator institutional claim files including inpatient (hospital skilled facilities) fee-for-service beneficiaries entering during period calculated sensitivity positive value (PPV) diagnoses taken from hospital claims among new admissions hospitals (alpha reliability) pairs items within that logically should be related. also tested commonly based multi-item scales examined an severity measure viz. one year survival. Finally, we correspondence discharge record hospitalizations deaths seen claims, completeness assessments upon facility (SNF) admission. Each there were some 800,000 directly US 900,000 uninterrupted SNF stays. Comparing enrollment records with revealed reasonably good improved over time (by 2006 only 3% had no record, 5% stays MDS, but 20% discharges indicating hospitalization associated claim). PPV levels .6 .7 major like CHF, hypertension, diabetes. Internal consistency, measured by PPV, ADL other measuring impairments symptoms exceeded .9. Activities Daily Living (ADL) long form summary scale achieved alpha inter-consistency exceeding .85 .65 well being mood, .55 behavior, sustained even after stratification cognition. Changes Health, End-stage disease Symptoms Signs (CHESS) index, frailty was highly demonstrates reasonable both terms how correspond functioning behavioral items. reliability demonstrated suggest can useful research analysis. However, while improving, tracking still not indicate or mortality. It will important monitor performance 3.0 respect now it replaced version 2.0, using these results baseline exceeded.