Minimum Data Set Changes in Health, End-Stage Disease and Symptoms and Signs Scale: A Revised Measure to Predict Mortality in Nursing Home Residents.
OBJECTIVES
To revise the Minimum Data Set (MDS) Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scale, an MDS 2.0-based measure widely used to predict mortality in institutional settings, in response to the release of MDS 3.0.


DESIGN
Development of a predictive scale using observational data from the MDS and Medicare Master Beneficiary Summary File.


SETTING
All Centers for Medicare and Medicaid Services (CMS)-certified nursing homes in the United States.


PARTICIPANTS
Development cohort of 1.3 million Medicare beneficiaries newly admitted to a CMS-certified nursing home during 2012. Primary validation cohort of 1.2 million Medicare recipients who were newly admitted to a CMS-certified nursing home during 2013.


MEASUREMENTS
Items from the MDS 3.0 assessments identified as likely to predict mortality. Death information was obtained from the Medicare Master Beneficiary Summary File.


RESULTS
MDS-CHESS 3.0 scores ranges from 0 (most stable) to 5 (least stable). Ninety-two percent of the primary validation sample with a CHESS scale score of 5 and 15% with a CHESS scale of 0 died within 1 year. The risk of dying was 1.63 times as great (95% CI=1.628-1.638) for each unit increase in CHESS scale score. The MDS-CHESS 3.0 is also strongly related to hospitalization within 30 days and successful discharge to the community. The scale predicted death in long-stay residents at 30 days (C=0.759, 95% confidence interval (CI)=0.756-0.761), 60 days (C=0.716, 95% CI=0.714-0.718) and 1 year (C=0.655, 95% CI=0.654-0.657).


CONCLUSION
The MDS-CHESS 3.0 predicts mortality in newly admitted and long-stay nursing home populations. The additional relationship to hospitalizations and successful discharges to community increases the utility of this scale as a potential risk adjustment tool.
['Ogarek|Jessica A|JA|', 'McCreedy|Ellen M|EM|', 'Thomas|Kali S|KS|', 'Teno|Joan M|JM|', 'Gozalo|Pedro L|PL|']
D000368:Aged D000369:Aged, 80 and over D014487:Centers for Medicare and Medicaid Services, U.S. D015331:Cohort Studies D003661:Decision Support Techniques D005260:Female D006304:Health Status D006760:Hospitalization D006801:Humans D008297:Male D006278:Medicare D009026:Mortality D009735:Nursing Homes D014481:United States
mortality nursing home risk adjustment frailty health instability