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 ADL Assessment Reliable, Valid; Providers Show Marked Improvements For Residents, Study Finds

Admission and discharge assessments on mandatory reporting forms will help regulators, researchers, and providers get a handle on how well rehabilitation efforts are working for millions of Medicare residents, a new study claims.
In October 2010, regulators began requiring care providers to record activities of daily living (ADL) assessments in the new Minimum Data Set 3.0.  Five years later, a team led by Andrea Wysocki at Mathematica Policy Research in Washington, D.C., is offering “the first comprehensive examination” of the real-world implications of the assessments. Their findings? That the assessments “are largely complete at both admission and discharge” and may offer the kind of careful, objective analysis of post-acute care that provider advocates have wished for.
“The lack of systematic national data on short-stay nursing home residents has precluded more thorough analyses of resident characteristics related to functional outcomes during post-acute stays and of facility-level performance,” Wysocki writes in the latest issue of the Journal of the American Medical Directors Association (JAMDA). “The completeness and accuracy of the ADL measures for full episodes of care is important for clinical staff who are tracking the progress of residents and determining appropriate discharge timing. More frequent assessment of these measures also is valuable for therapy staff who [are] working with individuals to achieve specific benchmarks of self-care.”
Not only that, Wysocki adds, but the early data show what many providers have already known: Post-acute care works. More than 60 percent of residents in the study’s sample improved over the course of their stay. Those who didn’t improve as much were more likely to suffer from cognitive impairment, delirium, dementia, heart failure, or stroke, the researchers found.
The last half-decade has seen legislators and policymakers push Medicare out of the old, fee-for-service model and into what many wonks call “value-based purchasing.” Within three years, at least half of Medicare payments will pass through accountable care organizations or other bundled payment systems, the Obama administration claims.
At the same time, providers are eager to come up with a system of weights and measures so that—at a minimum—people are always comparing like with like when analyzing health care quality and costs. Last year, President Obama signed the IMPACT Act, which requires regulators to create a unified system of quality measures for health care.
Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.
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