Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare

Abstract

Objective: To assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). Data Sources: MDS assessments and Medicare claims, 2011-2015. Study Design/Methods: We linked inpatient claims for major injury falls with MDS assessments. The proportion of claims-identified falls reported for each fall-related MDS item was calculated. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. We created a claims-based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures. Principal Findings: We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long-stay (62.9 percent) than short-stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). Adjusting for facility-level race differences, reporting was lower for nonwhite people than white people; holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. The correlation between fall rates based on claims vs the MDS was 0.22. Conclusions: The nursing home-reported data used for the NHC falls measure may be highly inaccurate.