February 26, 2016: Pragmatic Trials in Nursing Homes

February 26, 2016: Pragmatic Trials in Nursing Homes

Topic

Pragmatic Trials in Nursing Homes: Benefits of a Uniform Minimal Clinical Data Set Linked to Medicare Data

Presenter

Vincent Mor, PhD, Brown University School of Public Health

Keywords

Pragmatic clinical trials; Nursing homes; Medicare; CMS; Clinical data set; Minimum data set; MDS

Key Points

  • The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of comprehensive assessment for all residents in a Medicare- or Medicaid-certified long-term care facility.
  • The MDS contains items that measure physical, psychological, and psychosocial functioning. The items in the MDS give a multidimensional view of the patient’s functional capacities and help staff to identify health problems.
  • Because skilled nursing home settings also function as rehabilitation centers that provide specialized care for patients with complex conditions, they offer a way to learn a great deal about how to deliver healthcare to different types of patients.
  • With national MDS, patient admission and prevalent population can be differentiated at the state, county, and provider level. The availability of detailed, uniform, longitudinal person-level clinical and functional data opens the way to many investigations otherwise not possible.

Discussion Themes

Who consents for nursing home participation in cluster-randomized trials?

With respect to the statistical power of large data sets, how are minor—yet significant—differences used in terms of policy-setting or management changes?

Dr. Mor’s PROVEN trial is a cluster-randomized pragmatic trial evaluating the effectiveness of a video-based advanced care planning program in Medicare/Medicaid-certified facilities in two large healthcare systems. The study is using electronic medical records and MDS data and will compare hospitalizations, advance directives, and hospice use between facilities in the two study arms.

For More Information

Read more about the national long-term care minimum data set at CMS: http://go.cms.gov/1LQ7A5Z.

The Brown School of Public Health hosts the LTCfocus website, updated through 2014, that provides data on nursing home care in the United States. Researchers can create maps and download data to trace relationships between state policies, local market forces, and the quality of long-term care. Access the site here: http://ltcfocus.org/.

For more information on the NIH Collaboratory-supported PROVEN pragmatic trial, click here: http://bit.ly/1GsRRIz.

Tags
#ClusterRandomization; #LongTermCare; #pctGR
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