Can administrative data identify active diagnoses for long-term care resident assessment?

Area of Science:

• Health Services Research
• Geriatric Medicine
• Health Informatics

Background:

• Veterans Affairs (VA) nursing homes provide rehabilitation services to many veterans.
• Accurate identification of active diagnoses is crucial for effective care planning and outcomes assessment in these settings.
• Existing VA administrative data sources require validation for identifying current patient diagnoses.

Purpose of the Study:

• To determine if diagnostic data from VA databases can accurately identify active diagnoses for Minimum Data Set (MDS) assessments.
• To evaluate the utility of VA administrative data for capturing diagnoses relevant to MDS version 3.0.
• To assess the feasibility of using readily available VA data for clinical care management.

Main Methods:

• A research nurse and a clinical nurse reviewed medical records of VA nursing home residents to identify active diagnoses, serving as the gold standard.
• Inpatient and outpatient diagnoses were extracted from the VA National Patient Care Database for the preceding year.
• Statistical measures including kappa, sensitivity, and specificity were calculated to compare database diagnoses with nurse assessments.

Main Results:

• Kappa values comparing research nurse assessments with VA database diagnoses were generally poor, with only 8 of 19 diagnoses exceeding a kappa value of 0.60.
• Agreement levels between the clinical nurse and administrative data were similarly low.
• The study found significant discrepancies between diagnoses documented in VA administrative databases and those identified through manual medical record review.

Conclusions:

• VA administrative data are not sufficiently accurate for identifying active diagnoses in nursing home residents.
• Current methods of data collection may not capture the full spectrum of active diagnoses relevant for veteran care.
• Further research is needed to establish efficient and reliable methods for collecting diagnostic data in VA nursing homes.