Hidden treasure lurks in data

MDS and MEDPAR to be linked

Nursing home patients in New York who require hospitalization will take part in a one-year study to determine if patterns of care are evident between acute and post-acute care.

What makes the Health Care Financing Administration-funded (HCFA) project unique is that computer medical records will be used to detect patterns of care. In fact, the $300,000 project, spearheaded by Lake Success, NY-based IPRO, will for the first time link the Minimum Data Set (MDS) and MEDPAR, a database of records of Medicare patients discharged from hospitals.

Information from the study will be used to compare nursing facility and acute care admissions and identify areas for quality improvement projects in hospitals and nursing homes. Opportunities to communicate with Medicare beneficiaries and their families on care will also be presented through the study.

Practical applications of the study might include finding better ways to treat nursing home patients prior to hospital admission, says Harry Feder, senior vice president of IPRO. "By looking at pneumonia admissions, for example, we might determine that a significant number of [acute] admissions could be prevented by allowing earlier initiation of treatments, or if the nursing facility was able to provide IV antibiotic therapy," he explains.

IPRO will combine the databases and supplement it with a link to the Medicaid Management Information System (MMIS) — a program for patients who have exhausted Medicare benefits. Incorporating the MMIS will include patients who often fall through regulatory cracks by moving from Medicaid-covered skilled nursing care to Medicare-covered acute care.

Objectives of the study include:

• investigating patterns of nursing facility transfers to hospitals;

• investigating the accuracy of admission sources in the MEDPAR database for admissions from nursing facilities to hospitals;

• reviewing conditions in the linked data sets explored in the literature and comparing rates with those in New York;

• evaluating the range of diseases and conditions that affect the transfer of nursing facility patients to New York hospitals;

• exploring methods to improve the quality of care of nursing facility patients so that hospital admissions are described including the identification of a quality improvement project;

• increasing the availability of preventive services to nursing facility residents with specific diseases and conditions;

• increasing clinical monitoring of patients’ medical conditions to reduce inappropriate hospital transfers, such as laboratory testing for digoxin and anticoagulation.