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 S E C T O R S Residential Adult Day Hospice Nursing Home Home Health Care Services 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 0 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  Electronic Health Records (EHR)  Daily Roster  Paper charts  Daily attendance record  Care plans  Billing records  Pay roll  Corporate HR systems  Universal Assessment tool  Daily/weekly/monthly/annual  Physicians reports reports   Intake records Manually compiled spread  sheets/word documents Dietary notes   Electronic data bases 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?

Example Use of Data Sources  Intake records/Universal assessment tool  Care plan  Paper charts  Daily roster  EHR  Staff knowledge  Physician Report  No records kept

 “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 ones 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 of 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

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 of the Centers for Disease Control and Prevention National Center for Health Statistics