What your MDS reports can do for you: learn to extract key data from your reports to drive up quality care.

You know that the Minimum Data Set (MDS) is a key source of information for nursing home professionals. But are you familiar with your MDS reports and what they can tell you about resident census, acuity, and staffing needs to keep you at the top of your professional game?

Some long-term care professionals, whether it's because they don't feel terribly computer literate or are unaware of the system, don't access MDS reports or use the data to help them help their facilities.

You're sitting on a gold mine of valuable information, says Roberta D. Reed, MSN, RN, NHA, a former surveyor currently working for a nursing facility chain in Ohio. "Someone else in your corporation may be [reviewing the reports] and analyzing how you're doing your job," she says.

There are two stages to becoming an expert on electronic data reports. First, identify and become familiar with the available reports, and, second, learn how to use applicable reports to improve quality.

Essential reports to know

Here's a summary of the different reports from your validation report folder in the CASPER system and how you can use them to help you with your MDSs:

* Initial feedback report. This report comes up almost immediately after you transmit MDSs. It will indicate whether the submission is a test or production submission. Unless directed otherwise, a facility should not send test submissions, says David Kordich, a clinical reimbursement coordinator at Extendicare Health Services, Inc., in Milwaukee.

Save the report as proof that the record was successfully accepted into the state database.

* Final validation report. This summary lets you know within 24 hours of transmission which assessments the state database has successfully accepted. Have someone check this report on a regular basis, Reed says.

This report is extremely important to the facility because it gives detailed information for each MDS record that has been submitted, says Kordich. "Not only will the report indicate whether the MDS record has been accepted or rejected, but it also describes any errors encountered in the record. It is crucial that the facility check for rejected records due to fatal errors and, when necessary, correct and resubmit them to the state's database," he advises.

Save this with the Initial Feedback Report.

* Provider detail listing of successfully grouped records report. Also check this report on a regular basis, Reed suggests, because it can identify errors in your software system, such as in your Resource Utilization Group assignments. Unfortunately, however, this report is not available in all states.

* End-of-month roster report. This report is useful to make sure that the state database accepted your initial MDSs, as well as any discharge and reentry tracking forms. "It will help you verify that discharge and reentry tracking forms, along with assessments, were submitted accurately," Reed explains.

* Resident discharged without return. This scheduled report lists residents who were discharged without their return anticipated. "End-of-the-month roster report names should not be on this report," Reed says. You may want to access the online report rather than this one, because you can set your own date range for the data when you request it over the Internet.

* MDS activity report. Management may use this report to determine the amount of time the MDS coordinator spends on the MDS assessment process. "It can really justify why [the MDS coordinator might] need more help," says Reed.

* MDS new admission report. You can use this to cross-check your monthly admissions, but if your facility has a corporate headquarters, management may use it to make sure your facility is staying on top of admission assessments, Reed warns. So make sure you know what it says about what your staff have completed.

* MDS residents with changes to resident identifiers. This report will only come up if you change a resident's birth date, gender, reason for assessment, or assessment reference date on an MDS. "If it's correct, do nothing. If it's wrong, correcting the error will prevent a duplicate resident from appearing on quarterly case-mix reports," Reed advises.

* MDS questionable new resident report. "This report comes up if the state [database] believes this resident is not a new resident," says Reed. It may also pop up when you submit assessments out of sequence. If the MDS is accurate, the database will eventually correct itself.

* MDS missing assessment report. This is a good report to keep an eye on, according to Reed, because it lets you know when you miss something. It often comes up when a facility experiences a change in MDS coordinators and an assessment falls by the wayside. This report will indicate the last assessment that was received by the state, Kordich says.

"Changes in your software system should not affect this report," Reed adds, so assessments that show up on this report are probably due to another cause. But if the cause is simple, such as transmitting an assessment late because the resident was in the hospital, the report should correct itself once you submit the missing assessment.

* Monthly quality indicator (QI) comparison report. Don't bother too much with this report, Reed says, because it's not particularly timely. Your QI information shows up three months after the fact. Use the analytical QI reports for quality improvement initiatives.

* Preliminary calculation of MDS facility case-mix score report. This only appears in states that use case-mix scores for Medicaid residents, giving the preliminary results of their scores.

"This is a nice tool for case-mix facilities to utilize to determine which residents need to have the appropriate assessments completed--for example, Medicare Advantage change forms and discharge tracking forms," says Kordich.

If this report shows errors, you get a certain number of days to correct the report prior to the final calculation of the MDS facility case-mix score report.

* Facility QI profile characteristics report. This report lists all QIs and your facility's percentage in each, as well as the comparative percentage for the state and nation.

It flags any indicators above 90%, as well as all QIs that are sentinel events. Surveyors will pull up the past three months of these data before they inspect your facility to help them target resident records for review.

Facilities should use this information to review records, verify the accuracy of MDSs, and determine whether issues are avoidable.

RELATED ARTICLE: Strategic quality.

Accessing your quality indicator/quality measure (QI/QM) reports will give you some good leads on areas in which you can improve care in your nursing home.

"Compare percentages, review the residents who are listed, identify your concerns, and put quality improvement methods in process," says Roberta D. Reed, MSN, RN, NHA, a former surveyor currently working for a nursing facility chain in Ohio.

Reed gives the following general Minimum Data Set (MDS) tips to help you avoid flagging indicators unnecessarily:

1. "Know the skin integrity and weights of all your residents before they go to the hospital," she advises. After all, how many times has a resident returned to your facility from acute care with a pressure ulcer or extreme weight loss? Protect your facility's reputation for good care.

Your staff should even go so far as to call the hospital and inform the nurse in charge if your residents return from the hospital malnourished, dehydrated, or with serious skin issues, she adds. Flagging pressure ulcer and weight-loss QI/QMs is serious business.

2. Be careful with MDS item B4, cognitive skills for daily decision making, Reed says. "This item often does not have supporting documentation in the medical record." However, you need to have backup documentation to show why you made a certain MDS coding decision.

For instance, if you code the resident as "severely impaired" because he or she rarely makes his or her own decisions, you must define "rarely." The Resident Assessment Instrument User's Manual doesn't directly specify what this means, so have a policy in place clarifying how your facility codes this item, Reed explains.

--Noelle Shough

BY NOELLE SHOUGH, EXECUTIVE EDITOR