Using MDS data

1
Using MDS data

• David R. Gifford MD MPH
• July 19, 2004
• National Nursing Home Improvement Collaborative

2
History of MDS uses

• Assist with clinical practice
• Standardized Clinical Assessment
• Develop care plan
• Calculate quality indicators
• Internal quality improvement efforts
• External regulatory oversight
• Payment
• Public Reporting

3
MDS can be powerful tool

• Used to identify resident needs
• Used to determine resource allocation
• Used to predict clinical decline outcomes
• Used to target interventions and clinical
  programs facility wide

4
Barriers to harnessing MDS

• A required data collection tool for CMS and State
  Survey Agency
• Original intent minimized
• Confusion about MDS coding instructions
• Frequency of MDS completion

5

• Does MDS drive your practices or do you utilize
  MDS to assist your practices?

6
Using MDS for Pressure Ulcers

• Identify residents with PU at admission
• Identify worsening PU from admission
• Identify residents who are high-risk
• Use CHSRA or own definition
• Identify risk factors that need to be addressed
  by care plan
• Identify distribution of PU stage at admission

7
MDS coding Pressure Ulcers

• Use clinical information in medical record to
  translate or crosswalk with RAI/MDS manual
  instructions for staging of PU

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Clinical Information about Pressure Ulcers

• 1. Onset mode and date, worst stage it has been
  to date
• 2. Current depth, width, and length
• 3. Current state - exudate, inflammation, debris,
  scab
• 4. Recent treatments
• 5. Recent changes
• 6. If not otherwise recorded, overall state of
  this patient - other conditions, nutrition,
  activity level
• 7. Physiologically correct staging
• Stage 1
• Stage 2, new or healing or complicated
• Stage 3, new or healing or complicated
• Stage 4, new or healing or complicated