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.

Development and Evaluation of Candidate Standardized Patient Assessment Data Elements

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

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.

ResearchPublished Nov 15, 2019

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.

Topics

Document Details

Citation

RAND Style Manual
Edelen, Maria Orlando, Anthony Rodriguez, Sangeeta C. Ahluwalia, Emily K. Chen, Catherine C. Cohen, Sarah Dalton, Jason Michel Etchegaray, Wenjing Huang, Brenda Karkos, David J. Klein, Jaime Madrigano, Monique Martineau, Terry Moore, Patrick Orr, Jessica Phillips, Ben Schalet, Victoria Shier, Susan M. Paddock, and Denis Agniel, Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 2: Background and Methods), RAND Corporation, RR-3004-CMS, 2019. As of October 6, 2024: https://www.rand.org/pubs/research_reports/RR3004.html
Chicago Manual of Style
Edelen, Maria Orlando, Anthony Rodriguez, Sangeeta C. Ahluwalia, Emily K. Chen, Catherine C. Cohen, Sarah Dalton, Jason Michel Etchegaray, Wenjing Huang, Brenda Karkos, David J. Klein, Jaime Madrigano, Monique Martineau, Terry Moore, Patrick Orr, Jessica Phillips, Ben Schalet, Victoria Shier, Susan M. Paddock, and Denis Agniel, Development and Evaluation of Candidate Standardized Patient Assessment Data Elements: Findings from the National Beta Test (Volume 2: Background and Methods). Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR3004.html.
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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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