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  • Measure Summary
  • NQMC:010720
  • Oct 2015
  • NQF-Endorsed Measure

Long-stay nursing home care: percent of residents who self-report moderate to severe pain.

RTI International. MDS 3.0 quality measures user's manual, v9.0. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Oct 1. 80 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: RTI International. MDS 3.0 quality measures user's manual. v8.0. Baltimore (MD): Center for Medicare & Medicaid Services (CMS); 2013 Apr 15. 80 p.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percent of long-stay residents who self-report report either (1) almost constant or frequent moderate to severe pain in the last 5 days or (2) any very severe/horrible pain in the last 5 days.

Rationale

This measure is a high impact measure given the high proportion of residents with pain and the potentially serious physiological consequences of it not being treated. Research indicates that at least 40% to 85% of nursing facility residents have persistent pain. The percentage may be even higher; research suggests that pain is often not fully documented (Ferrell, Ferrell, & Osterweil, 1990; Parmelee, Smith, & Katz, 1993; Sengstaken & King, 1993; Weiner & Rudy, 2002; Centers for Medicare and Medicaid Services [CMS], n.d.; Mor et al., 2004; Wu et al., 2003).

Failure to identify the presence of pain or to assess its severity and functional impact can leave a potentially treatable symptom unrecognized and therefore unlikely to be addressed. Indeed, evidence suggests that pain is consistently under-treated, particularly among individuals with cognitive impairment (Sengstaken & King, 1993; Cook, Niven, & Downs, 1999; Won et al., 1999). A standard measure of resident pain is needed because of gaps in nursing staff's knowledge of "best practice" pain management in hospitals and nursing facilities (Weiner & Rudy, 2002; McMillan et al., 2000; Mrozek & Werner, 2001; Allcock, McGarry, & Elkan, 2002; Saliba & Buchanan, 2008). A standard measure also provides a benchmark for pain management practices that vary widely across nursing homes (Cramer et al., 2000; Allcock, McGarry, & Elkan, 2002; Saliba & Buchanan, 2008).

Among the potential adverse physiological and psychological effects of unrelieved pain are impaired gastrointestinal and pulmonary function; nausea and dyspnea; increased metabolic rate, including increased tumor growth and metastasis in cancer; impaired immune response; insomnia, delayed healing, increased blood clotting, loss of appetite, and the inability to walk or move about; impairment of joint function with functional decline and increased dependency; and anxiety and depression (Scherder & Bouma, 2000; Wrede-Seaman, 2001; Sachs, Shega, & Cox-Hayley, 2004; Hanson, Tulsky, & Danis, 1997). In the general population, unrelieved pain costs millions of dollars annually as a result of longer hospital stays, rehospitalizations, outpatient care, and emergency room visits (Berry & Dahl, 2001; Cousins, n.d.; Sydow, 1988; Wattwil, 1988; Desbiens et al., 1997; BenDebba, Torgerson, & Long, 1997; Liu, Carpenter, & Neal, 1995; McCaffery & Pasero, 1999; Hughes et al., 1997; Casten et al., 1995; Grant et al., 1995; Sheehan, et al., 1996).

Facilities can use this information to determine whether they need to improve their pain management practices for their long-stay residents. Reduced pain among long-stay nursing facility residents is the expected benefit of this measure.

Evidence for Rationale

Allcock N, McGarry J, Elkan R. Management of pain in older people within the nursing home: a preliminary study. Health Soc Care Community. 2002 Nov;10(6):464-71. PubMed External Web Site Policy

BenDebba M, Torgerson WS, Long DM. Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain. 1997 Aug;72(1-2):115-25. PubMed External Web Site Policy

Berry PH, Dahl JL. The new JCAHO pain standards: implications for pain management nurses. Pain Manag Nurs. 2000 Mar;1(1):3-12. [73 references] PubMed External Web Site Policy

Casten RJ, Parmelee PA, Kleban MH, Lawton MP, Katz IR. The relationships among anxiety, depression, and pain in a geriatric institutionalized sample. Pain. 1995 May;61(2):271-6. PubMed External Web Site Policy

Centers for Medicare and Medicaid Services (CMS). CMS MDS quality measure/indicator report. [internet]. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS);

Cook AK, Niven CA, Downs MG. Assessing the pain of people with cognitive impairment. Int J Geriatr Psychiatry. 1999 Jun;14(6):421-5. [29 references] PubMed External Web Site Policy

Cousins M. Acute post-operative pain. In: Wall PD, Melzak R, editor(s). Textbook of pain. 3rd ed. New York: Churchill Livingstone; p. 357-85.

Cramer GW, Galer BS, Mendelson MA, Thompson GD. A drug use evaluation of selected opioid and nonopioid analgesics in the nursing facility setting. J Am Geriatr Soc. 2000 Apr;48(4):398-404. PubMed External Web Site Policy

Desbiens NA, Mueller-Rizner N, Connors AF Jr, Hamel MB, Wenger NS. Pain in the oldest-old during hospitalization and up to one year later. HELP Investigators. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc. 1997 Oct;45(10):1167-72. PubMed External Web Site Policy

Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home. J Am Geriatr Soc. 1990 Apr;38(4):409-14. PubMed External Web Site Policy

Grant M, Ferrell BR, Rivera LM, Lee J. Unscheduled readmissions for uncontrolled symptoms. A health care challenge for nurses. Nurs Clin North Am. 1995 Dec;30(4):673-82. PubMed External Web Site Policy

Hanson LC, Tulsky JA, Danis M. Can clinical interventions change care at the end of life. Ann Intern Med. 1997 Mar 1;126(5):381-8. [65 references] PubMed External Web Site Policy

Hughes S, Gibbs J, Dunlop D, Edelman P, Singer R, Chang RW. Predictors of decline in manual performance in older adults. J Am Geriatr Soc. 1997 Aug;45(8):905-10. PubMed External Web Site Policy

Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995 Jun;82(6):1474-506. [379 references] PubMed External Web Site Policy

McCaffery M, Pasero C. Pain: clinical manual. St. Louis (MO): Mosby; 1999.

McMillan SC, Tittle M, Hagan S, Laughlin J, Tabler RE. Knowledge and attitudes of nurses in veterans hospitals about pain management in patients with cancer. Oncol Nurs Forum. 2000 Oct;27(9):1415-23. PubMed External Web Site Policy

Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. Milbank Q. 2004;82(2):227-56. PubMed External Web Site Policy

Mrozek JE, Werner JS. Nurses' attitudes toward pain, pain assessment, and pain management practices in long-term care facilities. Pain Manag Nurs. 2001 Dec;2(4):154-62. PubMed External Web Site Policy

National Quality Forum measure information: percent of residents who self-report moderate to severe pain (long stay). Washington (DC): National Quality Forum (NQF); 2016 Jan 13. 15 p.

Parmelee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc. 1993 May;41(5):517-22. PubMed External Web Site Policy

Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med. 2004 Oct;19(10):1057-63. [71 references] PubMed External Web Site Policy

Saliba D, Buchanan J. Development & validation of a revised nursing home assessment tool: MDS 3.0. Contract No. 500-00-0027/Task Order #2. Santa Monica (CA): Rand Corporation; 2008 Apr.

Scherder EJ, Bouma A. Visual analogue scales for pain assessment in Alzheimer's disease. Gerontology. 2000 Jan-Feb;46(1):47-53. PubMed External Web Site Policy

Sengstaken EA, King SA. The problems of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc. 1993 May;41(5):541-4. PubMed External Web Site Policy

Sheehan J, McKay J, Ryan M, Walsh N, O'Keeffe D. What cost chronic pain. Ir Med J. 1996 Nov-Dec;89(6):218-9. PubMed External Web Site Policy

Sydow FW. The influence of anesthesia and postoperative analgesic management of lung function. Acta Chir Scand Suppl. 1989;550:159-65; discussion 165-8. [20 references] PubMed External Web Site Policy

Wattwil M. Postoperative pain relief and gastrointestinal motility. Acta Chir Scand Suppl. 1989;550:140-5. [37 references] PubMed External Web Site Policy

Weiner DK, Rudy TE. Attitudinal barriers to effective treatment of persistent pain in nursing home residents. J Am Geriatr Soc. 2002 Dec;50(12):2035-40. PubMed External Web Site Policy

Won A, Lapane K, Gambassi G, Bernabei R, Mor V, Lipsitz LA. Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology. J Am Geriatr Soc. 1999 Aug;47(8):936-42. PubMed External Web Site Policy

Wrede-Seaman LD. Treatment options to manage pain at the end of life. Am J Hosp Palliat Care. 2001 Mar-Apr;18(2):89-101. [47 references] PubMed External Web Site Policy

Wu N, Miller SC, Lapane K, Gozalo P. The problem of assessment bias when measuring the hospice effect on nursing home residents' pain. J Pain Symptom Manage. 2003 Nov;26(5):998-1009. PubMed External Web Site Policy

Primary Health Components

Nursing home; long stay; pain

Denominator Description

All long-stay residents with a selected target assessment, except those with exclusions (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Long-stay residents with a selected target assessment where the target assessment meets either or both of the following two conditions:

  1. Condition #1: resident reports almost constant or frequent moderate to severe pain in the last 5 days. Both of the following conditions must be met:

    1.1. Almost constant or frequent pain, and
    1.2. At least one episode of moderate to severe pain.

  2. Condition #2: resident reports very severe/horrible pain of any frequency.

See the related "Numerator Inclusions/Exclusions" field.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Pain has been shown to have a negative effect on quality of life; it is associated with declines in autonomy, security, and spiritual well-being and increases in anxiety and depression (Herman et al., 2009). Existing research studies reviewing the impact of pain relief interventions at the actor, decision-support, treatment, and system levels agree that pain relief leads to increased quality of life (Degenholtz et al., 2008; Zanocchi et al., 2008; Kenefick, 2004).
  • Although the number of high-quality studies of pain management in nursing facilities is limited, those studies agree that resident pain is under-recognized and under-treated (Herman et al., 2009). A recent record audit of 291 residents in 14 long-term care facilities found a significant gap between evidence-based pain management recommendations and facility practices. Assessment was particularly weak; only 32% of the cases reported for pain once or twice a week, and only 3% of the cases reviewed had reported that pain impacted functioning and quality of life two or more times during the previous 30 days (Jablonski & Ersek, 2009). One study focusing on pain in cancer patients reported underuse of analgesics and hospice, along with nursing facility staffing patterns as key issues in inadequate pain treatment for this population (Duncan, Forbes-Thompson, & Bott, 2008). Many studies and literature maintain that almost all pain, including pain at the end of life, can be managed with appropriate assessment and treatment, and research in pain management has identified the adoption of systematic implementation models, clinical decision-making algorithms, interdisciplinary approaches, and ongoing outcome evaluations as effective means to deliver effective pain relief in nursing homes (Scherder & Bouma, 2000; Wrede-Seaman, 2001; Sachs, Shega, & Cox-Hayley, 2004; Hanson, Tulsky, & Danis, 1997; Swafford et al., 2009).
  • The literature reported mixed results for disparities in pain by race, gender, and age. Although there is evidence of racial segregation between nursing homes, with African Americans tending to be concentrated in facilities with higher deficiency ratings, there has been little study of resulting potential disparities in reported pain (Smith et al., 2007; Howard et al., 2002; Grabowski, 2004). The research conducted on racial disparities in pain treatment has shown a greater incidence of untreated pain for black residents with cancer as compared to white residents with cancer (Bernabei et al., 1998; Hanlon et al., 2009). Another study on nursing home residents with cancer found that older residents (equal to 86 years of age) were less likely and female residents were more likely to receive pain medication in the month of or the month after cancer diagnosis (Clement, Bradley, & Lin, 2009). A report based on 2004 National Nursing Home Survey has revealed disparities by race and dementia (Sengupta, Bercovitz, & Harris-Kojetin, 2010). Nonwhite residents with dementia were least likely, and white residents without dementia were most likely, to report or show signs of pain. Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management (Sengupta, Bercovitz, & Harris-Kojetin, 2010). However, a study on both community and institutionalized people found that persons with dementia had a higher probability of use of paracetamol and were about as likely as persons without dementia to use any analgesic, opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), after adjustment for confounders and the care setting (Hassum et al., 2011).

    Another study discovered that after controlling for facility characteristics (e.g., rural/urban location, percentage of Medicaid residents within the facilities, staffing and ownership), none of age, race, gender, Medicaid status was correlated with moderate to severe pain (Kang, Meng, & Miller, 2011). Research has also identified disparities in pain management between cognitively intact residents and those who are cognitively impaired (Lapane et al., 2010). In the current Minimum Data Set (MDS) 2.0 pain item, staff recording of cognitive status was inversely proportional to pain report; the most cognitively impaired residents were recording as suffering the least pain, and received the least pain therapy (Reynolds et al., 2008). In the MDS 3.0, new pain items were included that focus on patient interview and have been shown to be able to be answered by cognitively impaired residents (Saliba & Buchanan, 2008).

Evidence for Additional Information Supporting Need for the Measure

Bernabei R, Gambassi G, Lapane K, Landi F, Gatsonis C, Dunlop R, Lipsitz L, Steel K, Mor V. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA. 1998 Jun 17;279(23):1877-82. PubMed External Web Site Policy

Clement JP, Bradley CJ, Lin C. Organizational characteristics and cancer care for nursing home residents. Health Res Educ Trust. 2009 Dec;44(6):1983-2003. PubMed External Web Site Policy

Degenholtz HB, Rosen J, Castle N, Mittal V, Liu D. The association between changes in health status and nursing home resident quality of life. Gerontologist. 2008 Oct;48(5):584-92. PubMed External Web Site Policy

Duncan JG, Forbes-Thompson S, Bott MJ. Unmet symptom management needs of nursing home residents with cancer. Cancer Nurs. 2008 Jul-Aug;31(4):265-73. PubMed External Web Site Policy

Grabowski DC. The admission of blacks to high-deficiency nursing homes. Med Care. 2004 May;42(5):456-64. PubMed External Web Site Policy

Haasum Y, Fastbom J, Fratiglioni L, Kåreholt I, Johnell K. Pain treatment in elderly persons with and without dementia: a population-based study of institutionalized and home-dwelling elderly. Drugs Aging. 2011 Apr 1;28(4):283-93. PubMed External Web Site Policy

Hanlon JT, Wang X, Good CB, Rossi MI, Stone RA, Semla TP, Cunningham FE, Handler SM. Racial differences in medication use among older, long-stay Veterans Affairs Nursing Home Care Unit patients. Consult Pharm. 2009 Jun;24(6):439-46. PubMed External Web Site Policy

Hanson LC, Tulsky JA, Danis M. Can clinical interventions change care at the end of life. Ann Intern Med. 1997 Mar 1;126(5):381-8. [65 references] PubMed External Web Site Policy

Herman AD, Johnson TM, Ritchie CS, Parmelee PA. Pain management interventions in the nursing home: a structured review of the literature. J Am Geriatr Soc. 2009 Jul;57(7):1258-67. PubMed External Web Site Policy

Howard DL, Sloane PD, Zimmerman S, Eckert JK, Walsh JF, Buie VC, Taylor PJ, Koch GG. Distribution of African Americans in residential care/assisted living and nursing homes: more evidence of racial disparity. Am J Public Health. 2002 Aug;92(8):1272-7. PubMed External Web Site Policy

Jablonski A, Ersek M. Nursing home staff adherence to evidence-based pain management practices. J Gerontol Nurs. 2009 Jul;35(7):28-34; quiz 36-7. PubMed External Web Site Policy

Kang Y, Meng H, Miller NA. Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey. Gerontologist. 2011 Dec;51(6):761-73. PubMed External Web Site Policy

Kenefick AL. Pain treatment and quality of life: reducing depression and improving cognitive impairment. J Gerontol Nurs. 2004 May;30(5):22-9. PubMed External Web Site Policy

Lapane KL, Quilliam BJ, Chow W, Kim M. The association between pain and measures of well-being among nursing home residents. J Am Med Dir Assoc. 2012 May;13(4):344-9. PubMed External Web Site Policy

National Quality Forum measure information: percent of residents who self-report moderate to severe pain (long stay). Washington (DC): National Quality Forum (NQF); 2016 Jan 13. 15 p.

Reynolds KS, Hanson LC, DeVellis RF, Henderson M, Steinhauser KE. Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. J Pain Symptom Manage. 2008 Apr;35(4):388-96. PubMed External Web Site Policy

Sachs GA, Shega JW, Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med. 2004 Oct;19(10):1057-63. [71 references] PubMed External Web Site Policy

Saliba D, Buchanan J. Development & validation of a revised nursing home assessment tool: MDS 3.0. Baltimore (MD): Quality Measurement and Health Assessment Group, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services; 2008 Apr. 263 p.

Scherder EJ, Bouma A. Visual analogue scales for pain assessment in Alzheimer's disease. Gerontology. 2000 Jan-Feb;46(1):47-53. PubMed External Web Site Policy

Sengupta M, Bercovitz A, Harris-Kojetin LD. Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004. NCHS Data Brief. 2010 Mar;(30):1-8. PubMed External Web Site Policy

Smith DB, Feng Z, Fennell ML, Zinn JS, Mor V. Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes. Health Aff (Millwood). 2007 Sep-Oct;26(5):1448-58. PubMed External Web Site Policy

Swafford KL, Miller LL, Tsai PF, Herr KA, Ersek M. Improving the process of pain care in nursing homes: a literature synthesis. J Am Geriatr Soc. 2009 Jun;57(6):1080-7. PubMed External Web Site Policy

Wrede-Seaman LD. Treatment options to manage pain at the end of life. Am J Hosp Palliat Care. 2001 Mar-Apr;18(2):89-101. [47 references] PubMed External Web Site Policy

Zanocchi M, Maero B, Nicola E, Martinelli E, Luppino A, Gonella M, Gariglio F, Fissore L, Bardelli B, Obialero R, Molaschi M. Chronic pain in a sample of nursing home residents: prevalence, characteristics, influence on quality of life (QoL). Arch Gerontol Geriatr. 2008 Jul-Aug;47(1):121-8. PubMed External Web Site Policy

Extent of Measure Testing

A joint RAND/Harvard team engaged in a deliberate iterative process to incorporate provider and consumer input, expert consultation, scientific advances in clinical knowledge about screening and assessment, Centers for Medicare & Medicaid Services (CMS) experience, and intensive item development and testing by a national Veteran's Health Administration (VHA) consortium. This process allowed the final national testing of Minimum Data Set (MDS) 3.0 to include well-developed and tested items.

The national validation and evaluation of the MDS 3.0 included 71 community nursing homes (NHs) (3,822 residents) and 19 VHA NHs (764 residents), regionally distributed throughout the United States. The evaluation was designed to test and analyze inter-rater agreement (reliability) between gold-standard (research) nurses and between facility and gold-standard nurses, validity of key sections, response rates for interview items, anonymous feedback on changes from participating nurses, and time to complete the MDS assessment.

Analysis of the test results showed that MDS 3.0 items had either excellent or very good reliability even when comparing research nurse to facility-nurse assessment. In most instances these were higher than those seen in the past with MDS 2.0. In addition, for the cognitive, mood and behavior items, national testing included collection of independent criterion or gold-standard measures. These MDS 3.0 sections were more highly matched to criterion measures than were MDS 2.0 items.

Improvements incorporated in MDS 3.0 produced a more efficient assessment: better quality information was obtained in less time. Such gains should improve identification of resident needs and enhance resident-focused care planning. In addition, including 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.

Refer to Development & Validation of a Revised Nursing Home Assessment Tool: MDS 3.0. for additional information.

Evidence for Extent of Measure Testing

Saliba D, Buchanan J. Development & validation of a revised nursing home assessment tool: MDS 3.0. Baltimore (MD): Quality Measurement and Health Assessment Group, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services; 2008 Apr. 263 p.

State of Use

Current routine use

Current Use

Decision-making by consumers about health plan/provider choice

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Skilled Nursing Facilities/Nursing Homes

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Quarterly

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Institutionalization

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All long-stay* residents with a selected target assessment, except those with exclusions

*Long-stay: An episode with cumulative days in facility (CDIF) greater than or equal to 101 days as of the end of the target period.

Exclusions

  1. The target assessment is an admission assessment, a prospective payment system (PPS) 5-day assessment, or a PPS readmission/return assessment.
  2. The resident is not included in the numerator (the resident did not meet the pain symptom conditions for the numerator) and any of the following conditions are true:

    2.1. The pain assessment interview was not completed.
    2.2. The pain presence item was not completed.
    2.3. For residents with pain or hurting at any time in the last 5 days, any of the following are true:

    2.3.1. The pain frequency item was not completed.
    2.3.2. Neither of the pain intensity items was completed.
    2.3.3. The numeric pain intensity item indicates no pain.

Note: Refer to the original measure documentation for details.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Long-stay residents with a selected target assessment where the target assessment meets either or both of the following two conditions:

  1. Condition #1: resident reports almost constant or frequent moderate to severe pain in the last 5 days. Both of the following conditions must be met:

    1.1. Almost constant or frequent pain, and
    1.2. At least one episode of moderate to severe pain.

  2. Condition #2: resident reports very severe/horrible pain of any frequency.

Note: Refer to the original measure documentation for details.

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Type of Health State

Individually Reported Health State

Instruments Used and/or Associated with the Measure

Center for Medicare & Medicaid Services (CMS) Minimum Data Set (MDS) - Resident Assessment Instrument (Version 3.0)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

Risk adjustment refines raw quality measures (QM) scores to better reflect the prevalence of problems that facilities should be able to address. Two complementary approaches to risk adjustment are applied to the QMs.

One approach involves exclusion of residents whose outcomes are not under nursing facility control (e.g., outcome is evidenced on admission to the facility) or the outcome may be unavoidable (e.g., the resident has end-stage disease or is comatose). All of the QMs, except the vaccination QMs, are shaped by one or more exclusions. For each QM, the prevalence of the outcome across all residents in a nursing facility, after exclusions, is the facility-level observed QM score.

A second approach involves adjusting QM scores directly, using logistic regression. This method of adjustment employs resident-level covariates that are found to increase the risks of an outcome. Detailed specifications for resident-level covariates are presented in the Quality Measure Logical Specifications section of the MDS 3.0 Quality Measures User's Manual.

For this measure, resident-level limited covariate risk adjustment was used for persons with independence or modified independence in daily decision making on the prior Minimum Data Set (MDS) assessment:

  • Covariate = 1 if C1000 = [0, 1] or if (C0500 greater than or equal to [13] and C0500 less than or equal to [15])
  • Covariate = 0 if any of the following is true:
    1. C1000 = [2, 3] or
    2. (C0500 greater than or equal to [00] and C0500 less than or equal to [12]) or
    3. C0500 = [99,-,^] and C1000 = [-,^]
  • All covariates are missing if no prior assessment is available.

Standard of Comparison

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

Percent of residents who self-report moderate to severe pain (long-stay).

Measure Collection Name

Nursing Home Quality Initiative Measures

Measure Set Name

Long-stay Quality Measures

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

RTI International - Nonprofit Research Organization

Funding Source(s)

United States (U.S.) Government

Composition of the Group that Developed the Measure

United States (U.S.) Government Staff, Clinical Experts, Researchers, and Statisticians

Financial Disclosures/Other Potential Conflicts of Interest

No conflicts of interest exist.

Endorser

National Quality Forum

NQF Number

0677

Date of Endorsement

2014 Nov 3

Measure Initiative(s)

Nursing Home Compare

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Annual and endorsement

Date of Next Anticipated Revision

Quarter 4 2016

Measure Status

This is the current release of the measure.

This measure updates a previous version: RTI International. MDS 3.0 quality measures user's manual. v8.0. Baltimore (MD): Center for Medicare & Medicaid Services (CMS); 2013 Apr 15. 80 p.

Source(s)

RTI International. MDS 3.0 quality measures user's manual, v9.0. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Oct 1. 80 p.

Measure Availability

Source available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.

For more information, refer to the CMS Web site at www.cms.gov External Web Site Policy.

Companion Documents

The following are available:

  • Saliba D, Buchanan J. Development & validation of a revised nursing home assessment tool: MDS 3.0. Baltimore (MD): Quality Measurement and Health Assessment Group, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services; 2008 Apr. 263 p. Available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.
  • Nursing Home Compare. [internet]. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS). 2000- [updated 2012 Nov 15]; [cited 2012 Nov 27]. This tool is available from the Medicare Web site External Web Site Policy.

NQMC Status

The NQMC summary was completed by ECRI on July 22, 2004. The information was verified by the measure developer on August 30, 2004.

This NQMC summary was updated by ECRI on November 28, 2005. The information was verified by the measure developer on February 8, 2006 and again on October 17, 2007.

This NQMC summary was retrofitted into the new template on June 28, 2011.

This NQMC summary was updated by ECRI Institute on August 15, 2013. The information was verified by the measure developer on December 3, 2013.

This NQMC summary was updated again by ECRI Institute on May 31, 2016. The information was not verified by the measure developer.

Copyright Statement

No copyright restrictions apply.

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