Special Article
Overview of Significant Changes in the Minimum Data Set for Nursing Homes Version 3.0

https://doi.org/10.1016/j.jamda.2012.06.001Get rights and content

Abstract

The Minimum Data Set (MDS) is a standardized assessment that is completed on all residents admitted to Medicare certified nursing homes in the US. It is also completed on all residents admitted to Veteran Health Administration Community Living Centers. Its content addresses multiple domains of resident health and function and is intended to facilitate better recognition of each resident's needs. A new version of the MDS, MDS 3.0, was implemented in October, 2010. This article highlights significant clinical changes found in the MDS 3.0, including new structured resident interviews to assess mood, preferences, pain and cognition; inclusion of the Confusion Assessment Method to screen for delirium; revised psychosis and behavior items; revised balance and falls sections; revised bladder and bowel assessment items; revised pressure ulcer assessment items; revisions to the nutrition items; items reporting on resident expectations for return to the community; and changes to race/ethnicity item and language report. These changes aim to improve the clinical utility of these assessment items.

Section snippets

Methods for Revision

An accompanying article7 details the background and methods for developing and testing a draft MDS 3.0. Briefly, CMS contracted with RAND and its subcontractor, Harvard, to revise the MDS. Early stakeholder input established goals for the revision that included increasing clinical utility, improving reliability and accuracy, decreasing burden, and increasing resident voice in assessments. CMS also wanted revisions to support its current approach to prospective payment and quality indicator

Resident Voice Items

Perhaps the most significant conceptual change found in MDS 3.0 is the inclusion of direct resident interviews to assess several key domains of health—cognition, mood, preferences for daily routines, preferences for activities, and pain. The changes to these sections reflect those tested in the national test. For each section, a skip pattern instructs the assessor to attempt the interview with all residents who are able to make him or herself understood at least some of the time.

The MDS 3.0

Discussion

The MDS 3.0 includes significant changes across many of its sections. Many of these changes offer the opportunity to improve resident assessment and better inform care planning. The new resident interview items for cognition, mood, pain, and preferences have been tested for feasibility when administered by NH staff members to NH residents. These standardized interviews give providers a common basis for assessment across facilities and offer an opportunity to decrease differences in detection,

Limitations

Although assessment is an important clinical skill, assessment of many of the geriatric syndromes included in MDS is not consistently taught across disciplines. In addition, MDS has submission requirements (timing, frequency) and rules for coding administrative items that require training support for assessors. Prior to the implementation of MDS 3.0, CMS sponsored national trainings on MDS and posted instructions and training materials on its website. These are publicly available on the CMS

Conclusions

MDS 3.0 represents an opportunity to improve resident assessment and provide information for more individualized care plans. MDS 3.0 introduces structured, tested resident interviews along with significant changes across multiple clinical assessment items. These changes could improve assessment reliability and accuracy and provide an improved foundation for care planning. Many of the items and related assessment skills are potentially salient for ongoing clinical assessments and care planning

Acknowledgments

The many content and subject matter experts who contributed the development and testing of MDS 3.0 are acknowledged in an online appendix found at http://dx.doi.org/10.1016/j.jamda.2012.06.001

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    Parts of this work were funded by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) Service (Project SDR 03-217), the Centers for Medicare & Medicaid Services, and the UCLA/JH Borun Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the Centers for Medicare and Medicaid Services.

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