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MDS 3.0 History In response to changes in nursing home care, resident characteristics, advances in resident assessment methods, and provider and consumer concerns about the performance of the Minimum Data Set (MDS) 2.0, CMS contracted with RAND and Harvard to undertake a significant revision and national testing of Version 3.0 of the MDS. Importance The MDS is a potentially powerful tool for implementing standardized assessment and for facilitating care management in nursing homes (NHs). Its content has implications for residents, families, providers, researchers, and policymakers, all of whom have expressed concerns about the reliability, validity, and relevance of MDS 2.0. Some argue that because MDS 2.0 fails to include items that rely on direct resident interview, it fails to obtain critical information and effectively disenfranchises many residents from the assessment process. In addition, many users and government agencies have expressed concerns that the structure, length, and data collection burden of the MDS 2.0 exacerbate problems with data quality and validity when the MDS is collected by actual NH staff. Other stakeholders contend that items used in other care settings should be included to improve communication across providers. Improving the reliability, accuracy, and usefulness of the MDS has profound implications for NH care and public policy. Enhanced accuracy supports the primary legislative intent that MDS be a tool to improve clinical assessment and supports the credibility of programs that rely on MDS. In addition, most agree that the potential of the MDS to improve resident care can be realized only if providers do not view the MDS as an onerous data collection burden. Goals The goals of the MDS 3.0 revision were to introduce advances in assessment measures, increase the clinical relevance of items, improve the accuracy and validity of the tool, and increase the resident's voice by introducing more resident interview items. Providers, consumers, and other technical experts in NH care requested that MDS 3.0 revisions focus on improving the tool's clinical utility, clarity, and accuracy. CMS also wanted to shorten the tool while maintaining the ability to use MDS data for quality indicators, quality measures, and payment (resource utilization groups-III [RUGs-III] classification). In addition to improving the content and structure of the MDS, the RAND/Harvard team effort also aimed to improve user satisfaction. User attitudes are key determinants of quality improvement implementation. Negative user attitudes toward the MDS are often cited as a reason that NHs have not fully implemented it in targeted care planning. Key Findings for MDS 3.0 - Improved Resident Input
- Improved Accuracy and Reliability
- Increased Efficiency
- Improved Staff Satisfaction and Perception of Clinical Utility
Improvements incorporated in MDS 3.0 produce a more efficient assessment instrument: better quality information was obtained in less time. Such gains should improve identification of resident needs and enhance resident-focused care planning. In addition, inclusion of items recognized in other care settings is likely to enhance communication among providers. These significant gains reflect the cumulative effect of changes across the tool, including: - use of more valid items,
- direct inclusion of resident reports,
- improved clarity of retained items,
- deletion of poorly performing items, form redesign, and
- briefer assessment periods for clinical items.
Draft MDS 2.0/MDS 3.0 Crosswalk The Draft MDS 2.0 MDS 3.0 Crosswalk available below under the Downloads section incorporates the MDS 3.0 items currently proposed for implementation in October 2009. We anticipate that the vast majority of items contained in this initial draft crosswalk will appear on the final MDS 3.0. However, ongoing research and analysis could result in additions, deletions or revisions. The final list of MDS 3.0 items will be available by March 2009. This draft crosswalk: - Displays the MDS 3.0 item number, item label, item description, and response options.
- Also displays the MDS 2.0 item number, item label, item description, and item response options, when there is a corresponding or similar MDS 2.0 item for the MDS 3.0 item.
- Identifies items that have not been changed between the MDS 2.0 and MDS 3.0 as well as new items and items that have been revised.
- Reflects a change in the numbering system for MDS 3.0 to facilitate adding and deleting items. For example, on the MDS 2.0, bed mobility is G1a; on the MDS 3.0 it is G0100A. The extra zeros are placeholders in case of future item additions.
A second document, Draft MDS 3.0 Dropped Items available in the Download section of this page includes information about Dropped MDS 2.0 items are not included in this Draft MDS 2.0/ MDS 3.0 Crosswalk. Changes in MDS 3.0 items from MDS 2.0 items are based on results from the following: national MDS 3.0 study, national STRIVE study, CARE tool testing and recommendations from national experts in the long term care industry who participated in technical expert panels. The MDS 3.0 form will be finalized in March 2009 following completion of the evaluation and analysis of the impact of all potential items on various systems. The new assessment instrument will affect the following applications: Resource Utilization Groups (RUGs) used in the Skilled Nursing Facility Prospective Payment System and in some state Medicaid payment systems, Resident Assessment Protocols used for care planning and Quality Indicators and Quality Measures used for quality improvement activities. A possible new RUG system (RUG-IV) based on the MDS 3.0 is also being evaluated. After analysis of the amount of time that nursing home staff spend on residents and resident characteristics, the final payment items will be identified and the form will be updated to reflect the payment items. The information listed below under the "Downloads" section is subject to change. CMS will communicate any changes to these materials on this page as well as through Open Door Forums hosted by CMS. Draft MDS 3.0 Data Specifications Draft data submission specifications have been developed to support the new version of the MDS. In reviewing this documentation as well as the current draft of the new MDS 3.0 item set, it is important to note that all of these materials, including the specifications are currently in draft form and are subject to change prior to implementation. It is possible that MDS 3.0 items will be added, deleted, or revised prior to finalization. CMS is releasing the current drafts of the item set (Draft MDS 3.0 Item Set Draft.pdf), data specifications (Draft MDS 3.0 data specs.zip), and data dictionary (Draft MDS 3.0 data dictionary.zip) at this time, approximately a year before implementation, in order to give nursing home and swing bed providers, software developers, and other interested parties as much lead time as possible to prepare for implementation. However, there may be changes to the item set and to the data specifications before final versions are available. Questions regarding the data specifications should be directed to MDS30Comments@cms.hhs.gov. The information listed below under the "Downloads" section is subject to change. CMS will communicate any changes to these materials on this page as well as through Open Door Forums hosted by CMS.
Page Last Modified: 01/16/2009 9:44:38 AM
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