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. CMS tasked RAND with developing and testing the data elements. This report, Volume 7 of a series, presents test data and interpretations of the results for care preferences, medication reconciliation, and global health data elements.

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Development and Evaluation of Candidate Standardized Patient Assessment Data Elements

Findings from the National Beta Test (Volume 7: Global Health, Care Preferences, and Medication Reconciliation)

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 7 of the final report on the National Beta Test, which includes the identification and testing of candidate SPADEs that fall into other clinical categories (care preferences, medication reconciliation, and global health). 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 data elements tested include PROMIS Global Health, Care Preferences, and Medication Reconciliation. All three data element sets performed fairly well, with some variability in performance.

Key Findings

  • In terms of feasibility, missing data were very low for all three tested data element sets, but there was some variability in time to complete. The Global Health data elements, which include ten questions, took the longest to complete. The Care Preferences interview and chart review data elements were completed more quickly.
  • Responses to these data elements tended to be similar from admission to discharge, with the exception of PROMIS Global Health. Although there was a moderate degree of stability from admission to discharge for PROMIS Global Health, patients/residents at discharge were more likely to show improvement in symptoms than to worsen (compared with admission).
  • As with the quantitative results, assessor feedback is generally supportive of these data elements. This was particularly true for clinical utility, in that all data elements were deemed at least moderately clinically useful and, for Care Preferences and Medication Reconciliation, especially important for patient transfers.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Standardized Assessment of Global Health, Care Preferences, and Medication Reconciliation in Post-Acute Care

  • Chapter Three

    PROMIS Global Health

  • Chapter Four

    Care Preferences

  • Chapter Five

    Medication Reconciliation

  • Chapter Six

    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.