Comparison of methods to identify long term care nursing home residence with administrative data

James Goodwin, Shuang Li, Jie Zhou, James E. Graham, Amol Karmarkar, Kenneth Ottenbacher

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: To compare different methods for identifying a long term care (LTC) nursing home stay, distinct from stays in skilled nursing facilities (SNFs), to the method currently used by the Center for Medicare and Medicaid Services (CMS). We used national and Texas Medicare claims, Minimum Data Set (MDS), and Texas Medicaid data from 2011-2013. Methods: We used Medicare Part A and B and MDS data either alone or in combination to identify LTC nursing home stays by three methods. One method used Medicare Part A and B data; one method used Medicare Part A and MDS data; and the current CMS method used MDS data alone. We validated each method against Texas 2011 Medicare-Medicaid linked data for those with dual eligibility. Results: Using Medicaid data as a gold standard, all three methods had sensitivities > 92% to identify LTC nursing home stays of more than 100 days in duration. The positive predictive value (PPV) of the method that used both MDS and Medicare Part A data was 84.65% compared to 78.71% for the CMS method and 66.45% for the method using Part A and B Medicare. When the patient population was limited to those who also had a SNF stay, the PPV for identifying LTC nursing home was highest for the method using Medicare plus MDS data (88.1%). Conclusions: Using both Medicare and MDS data to identify LTC stays will lead to more accurate attribution of CMS nursing home quality indicators.

Original languageEnglish (US)
Article number376
JournalBMC Health Services Research
Volume17
Issue number1
DOIs
StatePublished - May 30 2017

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Long-Term Care
Nursing Homes
Medicare Part A
Centers for Medicare and Medicaid Services (U.S.)
Medicare Part B
Medicare
Medicaid
Skilled Nursing Facilities
Datasets

Keywords

  • Long term care
  • Medicare
  • Minimum Data Set
  • Nursing home

ASJC Scopus subject areas

  • Health Policy

Cite this

Comparison of methods to identify long term care nursing home residence with administrative data. / Goodwin, James; Li, Shuang; Zhou, Jie; Graham, James E.; Karmarkar, Amol; Ottenbacher, Kenneth.

In: BMC Health Services Research, Vol. 17, No. 1, 376, 30.05.2017.

Research output: Contribution to journalArticle

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