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Author Notes:

Correspondence: cbbowli@emory.edu C. Barrett Bowling

Each author made a substantial contribution, were involved in drafting and revising the manuscript and have given final approval of the version submitted. CBB was involved in the conceptualization of the manuscript, design of the study, interpreting the results, drafting the manuscript and making revisions of the manuscript. RZ was involved in the acquisition of the data, analysis of the data, interpretation of the results, drafting and revising the manuscript.

HF was involved in the conceptualization of the manuscript, interpreting the data and drafting and revising the manuscript.

AM was involved in interpreting the data and drafting and revising the manuscript.

WM was involved in the interpreting the data and drafting and revising the manuscript.

TMJ was involved in the interpreting the data and drafting and revising the manuscript.

NK was involved in the acquisition of the data, conceptualization of the manuscript, design of the study, interpreting the results, drafting the manuscript and making revisions of the manuscript.

All authors read and approved the final manuscript.

The authors declare they have no competing interests.

Subject:

Research Funding:

Support was provided through National Institutes of Health contract HHSN267200715004C, ADB No. N01-DK-7-5004; National Institute on Aging (R03AG042336-01), the T. Franklin Williams Scholarship Award (funding provided by: Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, the American Society of Nephrology and the American Geriatrics Society) and the Veterans Health Administration Clinical Science Research & Development (1IK2CX000856-01A1).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • Nursing home
  • End-stage renal disease
  • Frail elderly
  • STAGE RENAL-DISEASE
  • PATIENTS INITIATING DIALYSIS
  • MEDICARE CLAIMS DATA
  • UNITED-STATES
  • VALIDATION
  • ADULTS
  • FRAILTY
  • HEALTH
  • CARE
  • CKD

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

Tools:

Journal Title:

BMC Nephrology

Volume:

Volume 16, Number 1

Publisher:

, Pages 32-32

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2015 Bowling et al.; licensee BioMed Central.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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