• Journal Article

Sensitivity and Specificity of the Minimum Data Set 3.0 Discharge Data Relative to Medicare Claims

Citation

Rahman, M., Tyler, D., Acquah, J. K., Lima, J., & Mor, V. (2014). Sensitivity and Specificity of the Minimum Data Set 3.0 Discharge Data Relative to Medicare Claims. Journal of the American Medical Directors Association, 15(11), 819-824. DOI: 10.1016/j.jamda.2014.06.017

Abstract

Objective: The objective of this study was to determine whether the Minimum Data Set (MDS) 3.0 discharge record accurately identifies hospitalizations and deaths of nursing home residents.

Design: We merged date of death from Medicare enrollment data and hospital inpatient claims with MDS discharge records to check whether the same information can be verified from both the sources. We examined the association of 30-day rehospitalization rates from nursing homes calculated only from MDS and only from claims. We also examined how correspondence between these 2 data sources varies across nursing homes.

Settings: All fee-for-service (FFS) Medicare beneficiaries admitted for Medicare-paid (with prospective payment system) skilled nursing facility (SNF) care in 2011.

Results: Some 94% of hospitalization events in Medicare claims can be identified using MDS discharge records and 87% of hospitalization events detected in MDS data can be verified by Medicare hospital claims. Death can be identified almost perfectly from MDS discharge records. More than 99% of the variation in nursing homeelevel 30-day rehospitalization rate calculated using claims data can be explained by the same rates calculated using MDS. Nursing home structural characteristics explain only 5% of the variation in nursing homeelevel sensitivity and 3% of the variation in nursing homeelevel specificity.

Conclusion: The new MDS 3.0 discharge record matches Medicare enrollment and hospitalization claims events with a high degree of accuracy, meaning that hospitalization rates calculated based on MDS offer a good proxy for the "gold standard" Medicare data. (C) 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine.