Patterns revealed by Minimum Data Set entries and what they unearth about patient care can help providers perform better on quality measures, if that data is used to better understand and act on problem areas, according to one nurse assessment expert.
Major updates to the MDS rolled out in October included new coding requirements for quality measures such as declines in activities in daily living, pressure ulcers, and changes in mobility and function.
While many terms and processes with MDS quality measures can be confusing, it’s important for providers to take stock of their processes so they can achieve better outcomes, said Jessie McGill, curriculum development specialist at The American Association of Post-Acute Care Nursing.
“When we talk about the MDS and its role in quality measures, I like to consider it to be the alarm,” McGill told attendees of an educational event hosted by AAPACN Thursday. “The MDS is not the problem most likely.”
McGill compared the process to baking sourdough bread — if a baker’s loaf turns out poorly, they wouldn’t try to rebake the bread. Instead, they would adjust the process of making the dough. In the same way, she said, providers should use a quality measure trigger as a sign to examine its record keeping and direct care processes.
McGill mentioned one exception to this rule of thumb: when inaccurate coding around resident exclusions or covariates leads to irregularities. That should be the first thing providers check for, she said.
“The accuracy is the one thing that is within our control when it comes to covariates,” McGill explained. “We can make sure we have documentation and accurate MDS coding to ensure we have the accuracy on the quality measure reports.”
Providers also could check for any missing data generally and ensure that discharge assessments are being handled in a timely manner.
More broadly, though, providers should examine their care processes systematically — review documentation, ensure that physicians are adequately involved in care and that communication lines are open with direct care staff who may be able to detect changes in resident health early on.
“We have to do that root cause analysis to fix the problem. We can’t just go back to the MDS,” McGills said. “With your quality measures … you have to go back to that process and say, ‘What did I do wrong in the process? Was there a system error, a clinical mishap — what happened … that triggered a quality measure?’ And that’s how you work toward a process to future better outcomes.”
