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 1 of a series, summarizes the material presented in the other seven volumes.

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 1: Executive Summary)

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. Why and how was the National Beta Test conducted?
  2. What is the feasibility and reliability of each of the candidate SPADEs?
  3. What are the results across SPADEs in terms of validity, look-back differences (Day 3, 5, 7 repeat assessment and Day 1, 3, 5, 7 chart review), and stability/change from admission to discharge?
  4. Overall, how do the candidate SPADEs perform in terms of feasibility for use in PAC, psychometric performance, potential for improving quality, and utility for describing case mix?

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 1 of the final report on the National Beta Test. It summarizes the material presented in the other seven volumes, including background; methods and sample; basic feasibility and reliability results for each of the candidate SPADEs; results across SPADEs pertaining to evaluation of validity, look-back differences (Day 3, 5, 7 repeat assessment and Day 1, 3, 5, 7 chart review), and stability/change from admission to discharge; and a summary evaluation of the candidate SPADEs in terms of feasibility for use in PAC, psychometric performance, potential for improving quality, and utility for describing case mix.

Key Findings

The case for standardized PAC assessment

  • Using SPADEs across PAC settings offers the potential to improve coordination and integration of care, move toward more patient-centered care, improve discharge, facilitate interoperability, and develop outcomes-focused value-based payment models.

Conduct of the National Beta Test

  • Candidate SPADEs were identified for each of five areas of focus delineated in the IMPACT Act.
  • 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.
  • There were four primary goals for the data analysis: (1) to compute descriptive statistics for candidate SPADEs, (2) to determine the feasibility of administration, (3) to evaluate interrater reliability, and (4) to determine the content validity of candidate SPADEs.

Summary evaluation of candidate SPADEs

  • Results of the National Beta Test provided strong support for the feasibility of use of the majority of candidate SPADEs. In almost all cases, feasibility results according to these specifications were similar across the four setting types. There were very little missing data for any of the candidate SPADEs, and all candidate SPADEs took less than four minutes to complete.
  • The psychometric performance of the candidate SPADEs varied but, for the most part, tended to be within acceptable ranges and in line with expectations.
  • There are numerous indicators of the validity of the candidate SPADEs in the National Beta Test. The frequencies of responses and mean scores of each of the data elements across all assessment categories were very much in line with expectations, as were the associations of candidate SPADEs with patient/resident demographic and clinical characteristics.
  • All the candidate SPADEs that were selected for inclusion in the National Beta Test were evaluated by assessors as having the potential to improve quality in one or more respects, with assessors' ratings of clinical utility ranging from "somewhat" to "high."
  • The results of the National Beta Test provide only minimal information regarding the utility of the candidate SPADEs for describing case mix. However, all the candidate SPADEs fall into one of the clinical categories specified by the IMPACT Act.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

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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