Validity of the Minimum Data Set in Identifying Urinary Tract Infections in Residents of Long-Term Care Facilities

Authors


  • The analyses upon which this publication is based were performed under Contract 500–02-ID02, “Utilization and Quality Control Peer Review Organization for the State of Idaho,” sponsored by the Center for Medicare and Medicaid Services (CMS), Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care and therefore required no special funding on the part of this contractor. The authors welcome ideas and contributions concerning experience in engaging with the issues presented.

Address correspondence to Kurt B. Stevenson, MD, MPH, Qualis Health, 720 Park Boulevard, Suite 120, Boise, ID 83712. E-mail: kurts@qualishealth.org

Abstract

Objectives: To determine the validity of the Minimum Data Set (MDS) to detect cases of urinary tract infection (UTI) that meet specific evidence-based criteria.

Design: Prospective surveillance.

Setting: Sixteen long-term care facilities (LTCFs) in Idaho.

Participants: Residents of participating LTCFs for whom an MDS form was completed.

Measurements: Prospective surveillance of all types of infection, including UTI, and data collection on clinical manifestation, microbiology, and treatment; MDS data on identification of UTI.

Results: A stratified analysis demonstrated that the validity of MDS was 14% when using the evidence-based criteria for UTIs as the criterion standard. The estimated sensitivity and specificity of MDS entries were 57.9% and 86.5%, respectively. The estimated positive and negative predictive values for the study population were 13.9% and 98.2%, respectively.

Conclusion: MDS has the potential to be an important measure of quality in the long-term care setting. When used to detect residents with UTIs, it appears to greatly overestimate the number of cases while adequately screening out residents without UTIs. These problems may be overcome by providing more-explicit definitions for UTIs to be used by providers when completing MDS information on individual residents.

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