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 6 of a series, presents results for data elements in the categories of (1) impairments and (2) special services, treatments, and interventions.

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 6: Impairments and Special Services, Treatments, and Interventions)

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 6 of the final report on the National Beta Test. It describes the identification and testing of candidate SPADEs in the clinical categories of (1) impairments and (2) special services, treatments, and interventions (SSTIs). 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. Impairments data elements included (1) Hearing and Vision and (2) Bladder and Bowel Continence (both patient interview and chart review). SSTI data elements included (1) Nutritional Approaches and (2) Special Treatments. All five data element sets performed fairly well, showing feasibility, acceptable reliability, and moderate support from assessors.

Key Findings

All five data element sets performed well, with some variation

  • In terms of feasibility, missing data were very low for all five tested data element sets, but there was variability in time to complete, with the Continence Chart Review taking the longest.
  • Interrater reliability varied quite a bit across these five data element sets. The low rates of occurrence for many of the chart review data elements precluded calculation of kappas. The interrater reliability as represented by percent agreement was also somewhat variable, but the majority of these values were above 80 percent, reflecting acceptable agreement.
  • Evaluation of different look-back periods (Admission [Day 1] and Days 3, 5, 7; Discharge Day and Discharge Day minus 2) for the chart review data elements (Continence, Nutritional Approaches, Special Treatments) revealed that most data elements, if present, were noted on the first assessment day. That is, very little additional information was gained by extending the assessment window.
  • These data elements showed high stability from admission to discharge, with most patients/residents demonstrating no change.
  • Assessors found all five data elements to be at least moderately clinical useful, although they noted some concerns about implementation challenges related to data collection.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Standardized Assessment of Impairments and Special Services, Treatments, and Interventions in Post-Acute Care

  • Chapter Three

    Sensory Impairments: Hearing and Vision

  • Chapter Four

    Impairments: Continence Interview

  • Chapter Five

    Impairments: Continence Chart Review

  • Chapter Six

    Nutritional Approaches

  • Chapter Seven

    Special Treatments

  • Chapter Eight

    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.

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