Comparison of methods to identify long term care nursing home residence with administrative data

Table 2 Validation of different methods of identifying a long term care (LTC) nursing home stay using Medicare and MDS data, vs. data in Medicaid as the gold standard, in patients dually eligible for Medicare and Medicaid

Method	LTC nursing home length of stay in Medicaid data
	Cut off^a Length of stay >30 days	Cut off^a Length of stay >100 days
	N = 84,869	N = 53,837
1) Part A and B with E&M Charge for NH Services
Sensitivity	89.68%	92.55%
PPV^b		66.45%^b
2) Part A with MDS episode of care
Sensitivity	93.96%	93.09%
PPV	91.60%	84.65%
3) CMS Method: MDS alone
Sensitivity	77.49%	93.64%
PPV^b		78.71%^b

E&M evaluation and management, NH nursing home, PPV positive predictive value, MDS Minimum Data Set, CMS Centers for Medicare and Medicaid Services
^aFor cut off of > 30 or >100 day lengths of stay, the Medicaid data demonstrated > 30, and > 100 day length of stay in the validation
^bOnly one PPV could be detected for the different lengths of stay in methods one and three. Method one relies on provider charges to identify nursing home stays, and length of stay cannot be reliably estimated. Method three uses any length of stay in a nursing facility (whether skilled nursing facility or LTC) > 100 days as the criterion

ISSN: 1472-6963