Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 8, 2010
   Pages 719 — 724

Abstract — Can administrative data identify active diagnoses for long-term care resident assessment?

Dan R. Berlowitz, MD, MPH;1* Elaine C. Hickey, RN, MS;1 Debra Saliba, MD, MPH2

1Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and Boston University School of Public Health, Boston, MA; 2Greater Los Angeles Department of Veterans Affairs Geriatric Research, Education, and Clinical Center and Health Sciences Research and Development Center of Excellence, Los Angeles, CA; and University of California Los Angeles/Los Angeles Jewish Homes Borun Center, Los Angeles, CA

Abstract — Many veterans receive rehabilitation services in Department of Veterans Affairs (VA) nursing homes. Efficient methods for the identification of active diagnoses could facilitate care planning and outcomes assessment. We set out to determine whether diagnostic data from VA databases can be used to identify active diagnoses for Minimum Data Set (MDS) assessments. We evaluated diagnoses being considered for inclusion in MDS version 3.0 and present in at least 15% of a sample of VA nursing home residents. A research nurse following a standardized protocol identified active diagnoses from the medical records of 120 residents. A clinical nurse also identified active diagnoses in 58 of these patients. Inpatient and outpatient diagnoses from the VA National Patient Care Database were identified for the past year. We calculated kappa, sensitivity, and specificity values, considering the nurses' assessments the gold standard. We found that kappa values comparing research nurses and databases were generally poor, with only 8 of the 19 diagnoses having a value >0.60. Levels of agreement between the clinical nurse and administrative data were generally similar. We conclude that VA administrative data cannot be used to accurately identify active diagnoses for nursing home residents. How best to efficiently collect these important data remains uncertain.

Key words: active diagnosis, care planning, Community Living Centers, comorbidity, Minimum Data Set, nursing homes, outcomes data, rehabilitation, risk adjustment, veterans.

This article and any supplementary material should be cited as follows:

Berlowitz DR, Hickey EC, Saliba D. Can administrative data identify active diagnoses for long-term care resident assessment? J Rehabil Res Dev. 2010;47(8):719-24.


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Last Reviewed or Updated  Wednesday, October 27, 2010 11:57 AM

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