Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. E. MDS Accuracy


Several studies have identified serious accuracy problems with MDS data. The methods by which inaccuracies were determined varied across these studies but generally included either a review of whether medical record documentation contained information that supported the MDS findings and/or a comparison the nursing home's MDS assessments with those completed by highly trained nurses. The Abt MDS Accuracy Study reported that MDS error rates average 11.6 percent for all MDS items.27 That study reported the least accurate sections of the MDS included cognitive patterns (Section B), psychosocial well being (Section F), physical functioning (Section G), skin condition (Section M), and activity pursuit patterns (Section N). The study also noted problems with under-reporting in the areas of: vision, health conditions, pain, and falls; and over-reporting problems in the areas of: IV medication, intake and output, and physical, occupational and speech therapies. These areas of greatest disagreement generally require substantial periods of observation as well as resident or family interview in order to accurately assess.

Similarly, a study conducted by the Office of the Inspector General (OIG) of the MDS assessments completed for 640 nursing home residents, found errors on 17 percent of the MDS data elements (i.e., 17 percent of the MDS data elements were not supported by information in the medical record).28

In a study on nursing home resident assessment, the GAO reported that 9 of the 11 States that had MDS accuracy review programs found MDS errors occurring most frequently in the following categories: mood and behaviors, nursing rehabilitation and restorative care, activities of daily living, therapy, physician visits or orders, toileting plans, and skin conditions.29

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