Validation of the Standardized Function Data Elements among Medicare Skilled Nursing Facility Residents

• Published in: Journal of the American Medical Directors Association Vol. 24; no. 3; p. 307
• Main Authors: Toth, Matt, Palmer, Lauren, Marino, Molly E, Smith, Alice, Schwartz, Carole, Deutsch, Anne, McMullen, Tara
• Format: Journal Article
• Language: English
• Published: United States 01.03.2023
• Subjects: Activities of Daily Living; Aged; Hospitalization; Humans; Medicare; Patient Discharge; Patient Readmission; Retrospective Studies; Skilled Nursing Facilities; United States; United States; discharge destination; Medicare; IMPACT ACT; MDS; function; skilled nursing facilities
• ISSN: 1538-9375
• DOI: 10.1016/j.jamda.2022.12.014

To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge. Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge. Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs. We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity. Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements. Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents.