The residential history file: studying nursing home residents' long-term care histories(*)

Abstract

Objective: To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays.

Data sources: Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006.

Methods: The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death. The identification of residents in NHs is compared with the reports in OSCAR and part B claims.

Principal findings: The RHF correctly identified 84.8 percent of part B claims with place-of-service in NH, and it identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5 percent non-Medicare NH decedents were transferred to the hospital to die versus 45.6 percent skilled nursing facility decedents.

Conclusions: The population-based design of the RHF makes it possible to conduct policy-relevant research to examine the variation in the rate and type of health care transitions across the United States.

Figure 1

Sequence of Filling Calendar Days with Claims and MDS Information for Fictional Patient Notes. MDS assmnt, Minimum Data Set assessment (types are 1A, admission; 7O, other Medicare required; 8D, discharge); NH, nursing home; SAF, Medicare claims from standard analytic files; SNF, skilled nursing facility (Medicare paid nursing home care). Below calendar, upper panel shows the locations of care for the person in Example 1. Location variables are prefaced by HEE_, with variables presented for dates from and through, two overlapping locations, and indicator of death in the episodelet. Lower panel shows the data segments (claims, MDS assessments, Denominator indicator of death), which pertain to each of the episodelets. Segment variables are prefaced by HED_ with variables presented for dates of episodelet and segments and segment type (HED_TYPE).