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Open Access Research article

Validity of the RAI-MDS for ascertaining diabetes and comorbid conditions in long-term care facility residents

Lisa M Lix123*, Lin Yan23, David Blackburn2, Nianping Hu3, Verena Schneider-Lindner4 and Gary F Teare23

Author Affiliations

1 University of Manitoba, Winnipeg, MB, Canada

2 University of Saskatchewan, Saskatoon, SK, Canada

3 Health Quality Council, Saskatoon, SK, Canada

4 Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

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BMC Health Services Research 2014, 14:17  doi:10.1186/1472-6963-14-17

Published: 15 January 2014

Abstract

Background

This study assessed the validity of the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0 for diagnoses of diabetes and comorbid conditions in residents of long-term care facilities (LTCFs).

Methods

Hospital inpatient, outpatient physician billing, RAI-MDS, and population registry data for 1997 to 2011 from Saskatchewan, Canada were used to ascertain cases of diabetes and 12 comorbid conditions. Prevalence estimates were calculated for both RAI-MDS and administrative health data. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated using population-based administrative health data as the validation data source. Cohen’s κ was used to estimate agreement between the two data sources.

Results

23,217 LTCF residents were in the diabetes case ascertainment cohort. Diabetes prevalence was 25.3% in administrative health data and 21.9% in RAI-MDS data. Overall sensitivity of a RAI-MDS diabetes diagnoses was 0.79 (95% CI: 0.79, 0.80) and the PPV was 0.92 (95% CI: 0.91, 0.92), when compared to administrative health data. Sensitivity of the RAI-MDS for ascertaining comorbid conditions ranged from 0.21 for osteoporosis to 0.92 for multiple sclerosis; specificity was high for most conditions.

Conclusions

RAI-MDS clinical assessment data are sensitive to ascertain diabetes cases in LTCF populations when compared to administrative health data. For many comorbid conditions, RAI-MDS data have low validity when compared to administrative data. Risk-adjustment measures based on these comorbidities might not produce consistent results for RAI-MDS and administrative health data, which could affect the conclusions of studies about health outcomes and quality of care across facilities.

Keywords:
Chronic disease; Diagnostic validity; Long-term care; Nursing homes