The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss?

Authors

  • Sandra F. Simmons PhD,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
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  • Emily T. Garcia BA,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
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  • Mary P. Cadogan DrPh, RN, GNP,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. University of California at Los Angeles School of Nursing, Los Angeles, California
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  • Nahla R. Al-Samarrai MA,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
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  • Lene F. Levy-Storms PhD,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
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  • Dan Osterweil MD,

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
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  • John F. Schnelle PhD

    1. From the Department of Geriatrics, University of California at Los Angeles School of Medicine, Borun Center for Gerontological Research, Los Angeles, California
    2. Los Angeles Jewish Home for the Aging, Reseda, California
    3. Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda Geriatric Research, Education, and Clinical Center, Sepulveda, California.
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  • Supported by California Health Care Foundation Grant 99–5041 A. The California Health Care Foundation, based in Oakland, California, is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of the people of California. This research was also supported by Grant AG10415 from the National Institute on Aging, UCLA Claude D. Pepper Older Americans Independence Center.

Address correspondence to Sandra F. Simmons, PhD, Jewish Home for the Aging/UCLA Borun Center for Gerontological Research, 7150 Tampa Avenue, Reseda, CA 91335. E-mail: ssimmons@ucla.edu

Abstract

Objectives: To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss.

Design: Cross-sectional.

Setting: Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile—low prevalence) quartile and five NHs in the upper (75th percentile—high prevalence) quartile on the MDS weight-loss quality indicator.

Participants: Four hundred long-term residents.

Measurements: Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Trained research staff conducted measurement of NH staff implementation of each care process during assessments on three consecutive 12-hour days (7 a.m. to 7 p.m.), which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols.

Results: The prevalence of weight loss was significantly higher in the participants in the upper quartile NHs than in participants in the lower quartile NHs based on MDS and monthly weight data documented in the medical record. NHs with a higher prevalence of weight loss had a sig-nificantly larger proportion of residents with risk factors for weight loss, namely low oral food and fluid intake. There were few significant differences on care process measures between low- and high-weight-loss NHs. Staff in low-weight-loss NHs consistently provided verbal prompting and social interaction during meals to a greater proportion of residents, including those most at risk for weight loss.

Conclusion: The MDS weight-loss quality indicator reflects differences in the prevalence of weight loss between NHs. NHs with a lower prevalence of weight loss have fewer residents at risk for weight loss and staff who provide verbal prompting and social interaction to more residents during meals, but the adequacy and quality of feeding assistance care needs improvement in all NHs.

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