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 5 of a series, presents test data and interpretations of the results for data elements in the clinical categories of mental status and pain.

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Development and Evaluation of Candidate Standardized Patient Assessment Data Elements

Findings from the National Beta Test (Volume 5: Mental Status and Pain)

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 is the feasibility, reliability, and validity of these candidate SPADEs?
  2. What subset of candidate SPADEs can be standardized across PAC settings?
  3. What are the strengths and weaknesses of collecting these data elements in practice, based on the perspectives of research nurses and facility and staff assessors?

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 5 of the final report on the National Beta Test. It describes the identification and testing of candidate SPADEs in the clinical categories of mental status and pain. This volume provides results and significance tests on the feasibility, reliability, validity, stability and change over time, and sensitivity to national representativeness of the candidate SPADEs. The mental status data elements tested consisted of the Patient Health Questionnaire (PHQ)-2 to 9, Patient Reported Outcome Measurement Information System (PROMIS) Depression, and PROMIS Anxiety. The pain data element set tested was the Pain Interview. All four data element sets performed fairly well, showing feasibility, acceptable reliability, and moderate support from assessors.

Key Findings

All four data element sets performed well, but the mental status data elements were deemed burdensome to complete

  • In terms of feasibility, missing data were very low for all four tested data elements, and there was minimal variability in time to complete.
  • Interrater reliability was excellent for all data elements.
  • The majority of patients/residents did not exhibit significant change in their symptoms of depression, anxiety, and pain during their stay. Among those patients/residents who did exhibit change from admission to discharge, their symptoms improved over the course of the PAC stay, which implies that assessment of symptoms of depression, anxiety, and pain may be most informative at both admission and discharge.
  • Feedback from the clinical assessors in the National Beta Test indicated that the Pain Interview data elements had high clinical utility and reasonably low burden, whereas the mental status data elements had moderate clinical utility and relatively high data collection and patient burden.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Standardized Assessment of Mental Status and Pain

  • Chapter Three

    PHQ-2 to 9

  • Chapter Four

    PROMIS Depression

  • Chapter Five

    PROMIS Anxiety

  • Chapter Six

    Pain Interview

  • Chapter Seven

    Conclusion

  • Appendix

    Supplementary Tables

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.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.