The Minimum Data Set 2.0: A functional assessment to predict mortality in nursing home residents

Abstract

Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents. The paper has been designed as a retrospective study of residents in 24 Minnesota nursing homes who were referred to a hospice program. The study included 199 patients from 30 to 107 years of age. Functional variables, as triggered by the Minimum Data Set, have a direct correlation to patient mortality within three months of the documented observation of the triggered variable, and are the main outcome measure. Of a total of 199 patients, 147 patients (74 percent) died within 15 days of a documented significant decline in the Minimum Data Set in areas of cognitive function, communication, activities of daily living, incontinence, and nutrition. Age, gender, diagnosis, and significant medical data received from the nursing home staff at the time of referral to hospice were applied to the Karnofsky Scale, the Modified ADL Scale, the Descriptive Scale, and the Minimum Data Set to determine if a resident assessment protocol (RAP) would be triggered by these data. The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents. A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive functioning, communication, activities of daily living, incontinence, and nutrition, are strong predictors of short-term mortality in nursing home residents, independent of age, gender, and diagnosis.