Journal of the American Medical Directors Association
Special ArticleOverview of Significant Changes in the Minimum Data Set for Nursing Homes Version 3.0
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
References (44)
- et al.
Making the invenstment count: Revision of the minimum data set for nursing home, MDS 3.0
J Am Med Dir Assoc
(2012) - et al.
Testing the PHQ-9 interview and observational versions (PHQ-9 OV) for MDS 3.0
J Am Med Dir Assoc
(2012) - et al.
Identifying depression in primary care: A literature synthesis of case-finding instruments
Gen Hosp Psychiatry
(2002) - et al.
Measuring pain intensity in nursing home residents
J Pain Symptom Manage
(2005) - et al.
A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment
J Pain Symp Man
(2004) - et al.
MDS 3.0: Brief interview for mental status
J Am Med Dir Assoc
(2012) - et al.
Conceptual framework for rejection of care behaviors: Review of literature and analysis of role of dementia severity
J Am Med Dir Assoc
(2012) - et al.
A commitment to change: Revision of HCFA’s RAI
J Am Geriatr Soc
(1997) - et al.
Reliability estimates for the minimum data set for nursing home resident assessment and care screening (MDS)
Gerontologist
(1995) - Centers for Medicare and Medicaid Services. Nursing Home Compare. Available at: www.medicare.gov/nhcompare/home.asp....
Refining a case-mix measure for nursing homes: Resource utilization groups (RUG-III)
Med Care
Depressive symptoms and health-related quality of life: The Heart and Soul Study
JAMA
Performance of the PHQ-9 as a screening tool for depression after stroke
Stroke
Routine PHQ-9 depression screening in home health care: Depression, prevalence, clinical and treatment characteristics and screening implementation
Home Health Care Serv Q
Effect of improving depression care on pain and function among older adults with arthritis
JAMA
Monitoring depression treatment outcomes with the patient health questionnare-9
Med Care
Post-discharge hospital utilization among adult medical inpatients with depressive symptoms
J Hosp Med
Time course of depression and outcome of myocardial infarction
Arch Intern Med
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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.