Record Keeping Practices, Data Quality and Perceived Burden: Results - - PowerPoint PPT Presentation

Record Keeping Practices, Data Quality and Perceived Burden: Results from a Cognitive Interview Study Evaluating the National Study of Long-Term Care Providers

Meredith Massey, Manisha Sengupta and Lauren Harris-Kojetin Presented by Meredith Massey, PhD DC AAPOR 2019

Outline

• NSLTCP Background
• Study Design
• Findings

– Record Keeping – Data Quality – Burden

• Conclusions

NSLTCP Overview

• Sponsored by CDC’s National Center for Health

Statistics

• Integrated, biennial, multi-mode initiative to

monitor trends in paid, regulated long-term care

• Five sectors

– adult day services centers and participants – home health agencies and patients – hospices and patients – nursing homes and residents – residential care communities and residents

NSLTCP Sectors and Data Sources

Hospice Nursing Home Home Health Residential Care Adult Day Services

S E C T O R S D A T A S O U R C E S

Administrative records Survey questionnaire

Cognitive Interview Study Design

• 20 (17) Adult Day Centers or Residential Care Community Facilities
• 60 minute interviews conducted on-site
• Interviews conducted in Alabama, Washington, Virginia, Maryland, Kansas

and Washington, DC

• Recruitment
• Focused on how record keeping practices impacted respondents’ ability

to accurately and efficiently fill out the NSLTCP

Instrument

• 4 sections

– Background information

• Licensing, corporate structure, specialization

– Participant profile

• Demographics, Conditions, Assistance needed, living situation

– Services offered

• Fall assessment, medical services, transportation, hospice

– Staff profile

• Full-time/part-time, contract employees, RNs, CNAs, Activities staff

Variety of facilities

• Size
• Corporate structure
• Temporary to continuum of care
• Conditions represented
• Activities offered
• Facility demographics
• Funding sources
• Locations

Facility Characteristics

Facility Characteristics ADC RCC Size <10 1 10-50 2 1 50-100 7 3 >100 1 2 Number of locations 1 5 4 2+ 5 2 Ownership Private-non profit 4 2 Private- for profit 4 2 Publicly traded 1 2 Government 1 1

Data Sources

• Daily Roster
• Daily attendance record
• Billing records
• Corporate HR systems
• Daily/weekly/monthly/annual

reports

• Manually compiled spread

sheets/word documents

• Electronic data bases
• Electronic Health Records (EHR)
• Paper charts
• Care plans
• Pay roll
• Universal Assessment tool
• Physicians reports
• Intake records
• Dietary notes
• Staff knowledge

Data is used for

• Reporting to State and local agencies (licensing and compliance)
• Requesting program funds
• Insurance
• Billing/Medicaid reimbursement
• Reports to corporate owners
• Informing health care providers
• Updating family members
• Maintaining care plans for participants

Electronic or paper records?

Paper “I’m old-fashioned. I do everything by hand. I have all my life, with all my businesses… there aren’t many systems for day care. There are a few that are supposed to be very, very good, but I’ve never looked at them.”

Electronic or paper records?

EHR “We spent 8 years and a lot of money to get it running. It’s called ADS. It does everything including marketing leads, billing, medication, transport, client info- everything!”

Electronic or paper records?

Combination “…it includes a care plan, progress notes, interests and assessment tools. It can do a lot more but we’ve had it for 9 years and don’t use most of it… we also keep the paper charts. That’s just easier…. They’re easier to use.”

Example Use of Data Sources

• Of the participants currently enrolled

at this center, about how many have been diagnosed with each of the following conditions?

• Intake records/Universal assessment tool
• Care plan
• Paper charts
• Daily roster
• EHR
• Staff knowledge
• Physician Report
• No records kept

Example Use of Data Sources

• “It’s in each of their records. However, we don’t go

through and do each one, so for me, I would have to go through and find out how many people have particular diagnoses. It would probably take a while.”

Example Use of Data Sources

• Of this center’s revenue from paid

participant fees, about what percentage comes from each of the following sources? Your entries should add up to 100%

Example Use of Data Sources

• Billing records

– But! Who has access to these records?

• Staff knowledge + Daily Roster

– But! The percentage varies widely based on attendance and rate.

Example Use of Data Sources

“I could tell you which ones apply and which

• nes we don’t really have. Our primary funding

source comes from the Medicaid waiver. There’s also funding for one guy with the VA and one out

• f pocket from a participant’s family. Quite a few

private insurance. I’m not sure how worker’s comp fits in…. Honestly, I would probably just call our accounts receivable people!”

Example Use of Data Sources

• Of the participants enrolled at

this center, what is the racial/ethnic breakdown? Count each participant only once.

Example Use of Data Sources

• Intake records
• Staff guesses
• Rarely required for reporting

unless participants use ethnic- related services

Example Use of Data Sources

• “I have no idea!... You know, the first

problem is [race] is a guestimation. I was just wrong about one of our participants…I mean, it’s like half and half of people LOOK white or LOOK black, but I don’t really know.”

Example Use of Data Sources

• Of the participants currently enrolled

at this center, what is the age breakdown?

Example Use of Data Sources

• Intake records
• Daily roster
• Electronic Health Record
• Paper charts
• Birthday list
• Staff knowledge
• Accurate but in different format.

Example Use of Data Sources

“That…uhm..it’s not broken down quite that

• way. It’s above 60, below 60. 60 is the elderly

mark by the Medicaid waiver program. I don’t have those numbers off the top of my head but it is ascertainable. There should be a spreadsheet with birthdays.”

Impact of Record Keeping practices

• 4 sections

– Background information

• Licensing, corporate structure, specialization

– Participant profile

• Demographics, Conditions, Assistance needed, living situation

– Services offered

• Fall assessment, medical services, transportation, hospice

– Staff profile

• Full-time/part-time, contract employees, RNs, CNAs, Activities staff

Threats to data quality

• Records are not comparable across facilities
• Records are incomplete or missing
• Records do not correspond to response categories
• Respondents DO make an effort to respond accurately.

Factors that increase burden

• Larger facilities
• More than one person needed to gather information
• Respondent does not have access to all information
• Information is in different locations
• Paper charts
• Questions that require calculations (either percentages or because records are kept in

different format)

• Many (not all) respondents recognize the value of collecting this data

Moving forward

• Understand and respond to respondent burden
• Revise questions
• Revise answer categories
• More flexible implementation

National Center for Health Statistics

Thank you!

CCQDER: https://www.cdc.gov/nchs/CCQDER/ Reports available on Qbank: https://www.cdc.gov/qbank

National Study of Long-term Care Providers: https://www.cdc.gov/nchs/nsltcp/index.htm

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position

• f the Centers for Disease Control and Prevention