Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare

Abstract

Objective: To assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS).

Data sources: MDS assessments and Medicare claims, 2011-2015.

Study design/methods: We linked inpatient claims for major injury falls with MDS assessments. The proportion of claims-identified falls reported for each fall-related MDS item was calculated. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. We created a claims-based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures.

Principal findings: We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long-stay (62.9 percent) than short-stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). Adjusting for facility-level race differences, reporting was lower for nonwhite people than white people; holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. The correlation between fall rates based on claims vs the MDS was 0.22.

Conclusions: The nursing home-reported data used for the NHC falls measure may be highly inaccurate.

Keywords: disparities; falls; long term care; nursing homes; public reporting.

Figure 1

Linkage of Medicare admission claims with MDS assessments to create denominators for fall‐related MDS reporting outcomes. Notes: A, White boxes map out paths to the final denominators used to assess nursing home reporting of fall‐related items on the MDS. Gray boxes identify observations that were not used in analysis. B, J1700A‐J1900C refer to the specific MDS items under study and are described in Table 1. J1900C is the item that is used by CMS for quality reporting on NHC. C, CMS requires discharge assessments and items J1800‐J1900C in particular if a resident is admitted to a hospital. D, NH = nursing home