UCLA/Jewish Home Borun Center for Gerontological Research, Los Angeles, CA, USA.
J Am Med Dir Assoc. 2012 Sep;13(7):602-10. doi: 10.1016/j.jamda.2012.06.002. Epub 2012 Jul 13.
The Minimum Data Set (MDS) is a potentially powerful tool for implementing standardized assessment in nursing homes (NHs). Its content has implications for residents, families, providers, researchers, and policymakers, all of whom have expressed concerns about the reliability, validity, and relevance of MDS 2.0. Some argue that because MDS 2.0 fails to include items that rely on direct resident interview, it fails to obtain critical information and effectively disenfranchises many residents from the assessment process.
Design a major revision of the MDS, MDS 3.0, and evaluate whether the revision improves reliability, validity, resident input, clinical utility, and decreases collection burden.
In the form design phase, we gathered information from a wide range of experts, synthesized existing literature, worked with a national consortium of VA researchers to revise and test eight sections, pilot tested a draft MDS 3.0 and revised the draft based on results from the pilot. In the national validation and evaluation phase, we tested MDS 3.0 in 71 community NHs and 19 VHA NHs, regionally distributed throughout the United States. The sample was selected based on scheduled MDS 2.0 assessments. Comatose residents were excluded. A total 3822 residents of community NHs in eight states were included. The evaluation was designed to test and analyze inter-rater agreement (reliability) between research nurses and between facility staff and research nurses, validity of key sections, response rates for interview items, anonymous feedback on changes from participating nurses, and time to complete the MDS assessment.
The reliability for research nurse to research nurse and for research nurse to facility staff was good or excellent for most items. Response rates for the resident interview sections were high: 90% for cognitive, 86% for mood, 85% for preferences, and 87% for pain. Staff survey responses showed increased satisfaction with clinical relevance, validity and clarity compared with MDS 2.0. The test version of the MDS 3.0 took 45% less time for facilities to complete.
Improving the reliability, accuracy, and usefulness of the MDS has profound implications for NH care and public policy. Enhanced accuracy supports the primary legislative intent that MDS be a tool to improve clinical assessment and supports the credibility of programs that rely on MDS.
最小数据集 (MDS) 是在养老院 (NH) 中实施标准化评估的潜在强大工具。其内容对居民、家属、提供者、研究人员和政策制定者都有影响，他们都对 MDS 2.0 的可靠性、有效性和相关性表示担忧。一些人认为，由于 MDS 2.0 未能包含依赖居民直接访谈的项目，因此未能获得关键信息，并有效地剥夺了许多居民参与评估过程的权利。
设计 MDS 的重大修订版 MDS 3.0，并评估修订是否提高了可靠性、有效性、居民投入、临床实用性，并减少了收集负担。
在形式设计阶段，我们从广泛的专家那里收集信息，综合现有文献，与 VA 研究人员的全国联盟合作修订和测试八个部分，试点测试 MDS 3.0 草案，并根据试点结果修订草案。在全国验证和评估阶段，我们在美国各地的 71 家社区 NH 和 19 家 VHA NH 中测试了 MDS 3.0。样本是根据预定的 MDS 2.0 评估选择的。昏迷居民被排除在外。共有来自八个州的 3822 名社区 NH 居民被纳入。该评估旨在测试和分析研究护士之间以及设施工作人员和研究护士之间的评分者间一致性（可靠性）、关键部分的有效性、访谈项目的回复率、参与护士对变更的匿名反馈以及完成 MDS 评估所需的时间。
研究护士之间以及研究护士与设施工作人员之间的大多数项目的可靠性均为良好或优秀。居民访谈部分的回复率很高：认知部分为 90%，情绪部分为 86%，偏好部分为 85%，疼痛部分为 87%。工作人员调查反馈显示，与 MDS 2.0 相比，他们对临床相关性、有效性和清晰度的满意度有所提高。MDS 3.0 的测试版本使设施完成评估所需的时间减少了 45%。
提高 MDS 的准确性和有用性对 NH 护理和公共政策具有深远的意义。增强的准确性支持 MDS 作为改善临床评估的工具的主要立法意图，并支持依赖 MDS 的计划的可信度。
