Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk

Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has...
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Autor*in:	Bowling, C Barrett [verfasserIn] Zhang, Rebecca Franch, Harold Huang, Yijian Mirk, Anna McClellan, William M Johnson, Theodore M Kutner, Nancy G

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2015

Schlagwörter:	Nursing home End-stage renal disease Frail elderly

Anmerkung:	© Bowling et al.; licensee BioMed Central. 2015

Übergeordnetes Werk:	Enthalten in: BMC nephrology - London : BioMed Central, 2000, 16(2015), 1 vom: 21. März
Übergeordnetes Werk:	volume:16 ; year:2015 ; number:1 ; day:21 ; month:03

Links:	Volltext

DOI / URN:	10.1186/s12882-015-0021-9

Katalog-ID:	SPR027514862

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520			\|a Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care.
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allfields	10.1186/s12882-015-0021-9 doi (DE-627)SPR027514862 (SPR)s12882-015-0021-9-e DE-627 ger DE-627 rakwb eng Bowling, C Barrett verfasserin aut Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Bowling et al.; licensee BioMed Central. 2015 Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213 Zhang, Rebecca aut Franch, Harold aut Huang, Yijian aut Mirk, Anna aut McClellan, William M aut Johnson, Theodore M aut Kutner, Nancy G aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 21. März (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:21 month:03 https://dx.doi.org/10.1186/s12882-015-0021-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 21 03
spelling	10.1186/s12882-015-0021-9 doi (DE-627)SPR027514862 (SPR)s12882-015-0021-9-e DE-627 ger DE-627 rakwb eng Bowling, C Barrett verfasserin aut Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Bowling et al.; licensee BioMed Central. 2015 Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213 Zhang, Rebecca aut Franch, Harold aut Huang, Yijian aut Mirk, Anna aut McClellan, William M aut Johnson, Theodore M aut Kutner, Nancy G aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 21. März (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:21 month:03 https://dx.doi.org/10.1186/s12882-015-0021-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 21 03
allfields_unstemmed	10.1186/s12882-015-0021-9 doi (DE-627)SPR027514862 (SPR)s12882-015-0021-9-e DE-627 ger DE-627 rakwb eng Bowling, C Barrett verfasserin aut Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Bowling et al.; licensee BioMed Central. 2015 Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213 Zhang, Rebecca aut Franch, Harold aut Huang, Yijian aut Mirk, Anna aut McClellan, William M aut Johnson, Theodore M aut Kutner, Nancy G aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 21. März (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:21 month:03 https://dx.doi.org/10.1186/s12882-015-0021-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 21 03
allfieldsGer	10.1186/s12882-015-0021-9 doi (DE-627)SPR027514862 (SPR)s12882-015-0021-9-e DE-627 ger DE-627 rakwb eng Bowling, C Barrett verfasserin aut Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Bowling et al.; licensee BioMed Central. 2015 Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213 Zhang, Rebecca aut Franch, Harold aut Huang, Yijian aut Mirk, Anna aut McClellan, William M aut Johnson, Theodore M aut Kutner, Nancy G aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 21. März (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:21 month:03 https://dx.doi.org/10.1186/s12882-015-0021-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 21 03
allfieldsSound	10.1186/s12882-015-0021-9 doi (DE-627)SPR027514862 (SPR)s12882-015-0021-9-e DE-627 ger DE-627 rakwb eng Bowling, C Barrett verfasserin aut Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Bowling et al.; licensee BioMed Central. 2015 Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213 Zhang, Rebecca aut Franch, Harold aut Huang, Yijian aut Mirk, Anna aut McClellan, William M aut Johnson, Theodore M aut Kutner, Nancy G aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 21. März (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:21 month:03 https://dx.doi.org/10.1186/s12882-015-0021-9 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 21 03
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source	Enthalten in BMC nephrology 16(2015), 1 vom: 21. März volume:16 year:2015 number:1 day:21 month:03
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The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Nursing home</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">End-stage renal disease</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Frail elderly</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Zhang, Rebecca</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Franch, Harold</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Huang, Yijian</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Mirk, Anna</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">McClellan, William M</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Johnson, Theodore M</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Kutner, Nancy G</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="t">BMC nephrology</subfield><subfield code="d">London : BioMed Central, 2000</subfield><subfield code="g">16(2015), 1 vom: 21. 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author	Bowling, C Barrett
spellingShingle	Bowling, C Barrett misc Nursing home misc End-stage renal disease misc Frail elderly Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk
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topic_title	Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk Nursing home (dpeaa)DE-He213 End-stage renal disease (dpeaa)DE-He213 Frail elderly (dpeaa)DE-He213
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title	Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk
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title_full	Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk
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title_sort	underreporting of nursing home utilization on the cms-2728 in older incident dialysis patients and implications for assessing mortality risk
title_auth	Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk
abstract	Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. © Bowling et al.; licensee BioMed Central. 2015
abstractGer	Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. © Bowling et al.; licensee BioMed Central. 2015
abstract_unstemmed	Background The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care. © Bowling et al.; licensee BioMed Central. 2015
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title_short	Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk
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Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. Methods There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a “gold standard” metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. Results The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 – 1.64) for MDS/2728, 1.48 (1.42 – 1.54) for MDS/No 2728, and 1.38 (1.25 – 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. Conclusions The CMS-2728 underestimated NH utilization among older adults with incident ESRD. 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Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk

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