Doupe Malcolm B, Poss Jeff, Norton Peter G, Garland Allan, Dik Natalia, Zinnick Shauna, Lix Lisa M
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
BMC Health Serv Res. 2018 Apr 11;18(1):279. doi: 10.1186/s12913-018-3089-7.
To improve care, planners require accurate information about nursing home (NH) residents and their healthcare use. We evaluated how accurately measures of resident user status and healthcare use were captured in the Minimum Data Set (MDS) versus administrative data.
This retrospective observational cohort study was conducted on all NH residents (N = 8832) from Winnipeg, Manitoba, Canada, between April 1, 2011 and March 31, 2013. Six study measures exist. NH user status (newly admitted NH residents, those who transferred from one NH to another, and those who died) was measured using both MDS and administrative data. Rates of in-patient hospitalizations, emergency department (ED) visits without subsequent hospitalization, and physician examinations were also measured in each data source. We calculated the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and overall agreement (kappa, κ) of each measure as captured by MDS using administrative data as the reference source. Also for each measure, logistic regression tested if the level of disagreement between data systems was associated with resident age and sex plus NH owner-operator status.
MDS accurately identified newly admitted residents (κ = 0.97), those who transferred between NHs (κ = 0.90), and those who died (κ = 0.95). Measures of healthcare use were captured less accurately by MDS, with high levels of both under-reporting and false positives (e.g., for in-patient hospitalizations sensitivity = 0.58, PPV = 0.45), and moderate overall agreement levels (e.g., κ = 0.39 for ED visits). Disagreement was sometimes greater for younger males, and for residents living in for-profit NHs.
MDS can be used as a stand-alone tool to accurately capture basic measures of NH use (admission, transfer, and death), and by proxy NH length of stay. As compared to administrative data, MDS does not accurately capture NH resident healthcare use. Research investigating these and other healthcare transitions by NH residents requires a combination of the MDS and administrative data systems.
为改善护理服务，规划者需要有关养老院（NH）居民及其医疗保健使用情况的准确信息。我们评估了在最低数据集（MDS）与行政数据中，居民使用状态和医疗保健使用情况的测量准确性。
这项回顾性观察队列研究针对2011年4月1日至2013年3月31日期间加拿大曼尼托巴省温尼伯市的所有NH居民（N = 8832）进行。存在六项研究指标。使用MDS和行政数据测量NH用户状态（新入住NH的居民、从一个NH转到另一个NH的居民以及死亡居民）。还在每个数据源中测量住院率、随后未住院的急诊科（ED）就诊率和医生检查率。我们以行政数据作为参考来源，计算了MDS所捕获的每项指标的敏感性、特异性、阳性和阴性预测值（PPV、NPV）以及总体一致性（kappa，κ）。同样针对每项指标，逻辑回归检验了数据系统之间的不一致程度是否与居民年龄、性别以及NH所有者 - 经营者状态相关。
MDS准确识别了新入住居民（κ = 0.97）、在NH之间转移的居民（κ = 0.90）以及死亡居民（κ = 0.95）。MDS对医疗保健使用情况的测量准确性较低，存在大量漏报和假阳性情况（例如，住院的敏感性 = 0.58，PPV = 0.45），总体一致性水平中等（例如，ED就诊的κ = 0.39）。年轻男性以及居住在营利性NH中的居民有时不一致情况更为严重。
MDS可作为独立工具准确捕获NH使用的基本指标（入院、转移和死亡），并间接反映NH住院时间。与行政数据相比，MDS不能准确捕获NH居民的医疗保健使用情况。研究NH居民的这些及其他医疗保健转变情况需要结合MDS和行政数据系统。
