The Improving Medicare Post-Acute Care Transformation Act of 2014 mandates that the Centers for Medicare & Medicaid Services (CMS) use standardized patient assessment data elements across post-acute care settings. RAND was tasked by CMS with developing and testing the data elements. This report, Volume 2 of a series, focuses on the design and methods for the National Beta Test.

Cover: Development and Evaluation of Candidate Standardized Patient Assessment Data Elements
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Development and Evaluation of Candidate Standardized Patient Assessment Data Elements

Findings from the National Beta Test (Volume 2: Background and Methods)

by Maria Orlando Edelen, Anthony Rodriguez, Sangeeta C. Ahluwalia, Emily K. Chen, Catherine C. Cohen, Sarah Dalton, Jason Michel Etchegaray, Wenjing Huang, Brenda Karkos, David J. Klein, et al.

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Research Questions

  1. What activities informed the content and design of the National Beta Test?
  2. What candidate SPADEs were included in the National Beta Test, and how were quantitative and qualitative feedback gathered on them?
  3. What was the design and sampling plan of the National Beta Test?
  4. How were providers recruited to participate in the study, and how were research nurses recruited to administer the assessments?
  5. How were research nurses and facility/agency staff trained to conduct assessments?
  6. When and how was data collection conducted?
  7. How was data analysis conducted?

The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to evaluate candidate standardized patient assessment data elements (SPADEs) in a national field test titled the National Beta Test. The National Beta Test was conducted to evaluate the performance of candidate SPADEs in the clinical categories of (1) cognitive function and mental status; (2) special services, treatments, and interventions; (3) medical conditions and comorbidities; (4) impairments; and (5) other categories, for use in four post-acute care (PAC) settings: home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities.

This is Volume 2 of the final report on the National Beta Test. It focuses on the design and methods for the National Beta Test. This volume covers the candidate SPADEs tested; the design and sampling plan; information on training, recruitment, and retention; information on the data collection process and analytic plan.

Key Findings

Identification of candidate SPADEs

  • Candidate SPADEs to assess cognitive status included the Brief Interview for Mental Status, Confusion Assessment Method, and Staff Assessment of Mental Status.
  • Candidate SPADEs to address pain included a pain interview and staff assessment of pain or distress.
  • Candidate SPADES to address impairments included assessments for hearing and vision and bladder and bowel incontinence.
  • Candidate SPADES to address use of certain special services, treatments, and interventions focused on nutritional interventions, as well as others — for example, chemotherapy, radiation, and oxygen therapy.
  • Other candidate SPADEs assessed care preferences, medication reconciliation, and health-related quality of life.

Data collection and sample

  • Data were collected from a wide range of environments, allowing for thorough evaluation of candidate instruments in all PAC settings.
  • 143 PAC facilities/agencies in 14 markets across the country contributed patient/resident assessment data to the National Beta Test.
  • The test design called for assessment data to be collected at both admission and discharge by trained research nurses, as well as by trained facility/agency staff from each participating provider.

Data analysis

  • There were four primary goals for the data analysis: (1) to compute descriptive statistics for candidate SPADEs, (2) to determine the feasibility of administration, and (3) to evaluate interrater reliability between pairs of research nurses and facility/agency staff assessors, and (4) to determine the content validity of candidate SPADEs.
  • Secondary goals were also established. For example, some analyses examined differences in SPADE performance according to look-back period or assessment days.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Candidate SPADEs Included in National Beta Testing

  • Chapter Three

    Design and Sampling

  • Chapter Four

    Provider and Research Nurse Recruitment

  • Chapter Five

    Training

  • Chapter Six

    Data Collection

  • Chapter Seven

    Analytic Plan

  • Chapter Eight

    8888

  • Appendix A

    Past Performance, Current Use, and Input Opportunities for Candidate SPADEs Tested in the National Beta Test

  • Appendix B

    National Beta Test Research Nurse Training Agenda

  • Appendix C

    Example National Beta Test Field Training Agenda (Boston)

  • Appendix D

    National Beta Test Field Staff Web-Based Survey Questions

Research conducted by

The research described in this report was sponsored by the Centers for Medicare & Medicaid Services (CMS) and conducted by the Quality Measurement and Improvement Program within RAND Health Care.

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