THRIVE: The Research Initiative Valuing Eldercare

By / Posted on June 17th, 2013

 

 

 

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Why is the Minimum Data Set so Important for Research?
The Minimum Data Set (MDS) – nothing very “minimum” about it! – was developed to monitor and improve the quality of care in nursing homes. Nursing home staff use it to develop resident care plans, and the information is used more widely to develop quality measures and resource utilization group case-mix reports. Indeed, the MDS is the source of the quality information on the Federal Nursing Home Compare website (www.medicare.gov/nhcompare).

What many nursing home staff don’t realize is that MDS information is tremendously useful for research. After all, it’s not often that a mandate exists to report on the status of over 400 data elements for roughly 1.5 million people across 16,000 settings on a regular basis, is it? Beyond purposes of oversight, this information provides a tremendously rich data set to understand the needs of older adults who receive nursing home care, as well as how their needs change over time, and differences in the care they receive across different homes and regions of the country.

Of course, some information in the MDS is more useful for research than other information. A number of items create “standardized” scales, such as those that compose the Brief Interview for Mental Status (BIMS), or the depression scale from the Patient Health Questionnaire (PHQ-9). Before being included in the MDS, these scales were tested to assure they are of research quality in terms of how reliably and validly they actually document mental status and depression. Other scales have since been created from the MDS items, such as one summarizing resident function, and tested for research-quality.

Hundreds of research studies have been conducted with MDS information; in fact, a literature search found almost 800 such studies! The focus of recent research relates to differences in incontinence by race, the relationship of fracture risk to antipsychotic medication use, and the relationship between resident pain and behaviors; clearly, research such as this and others is helpful to inform practice and policy.

The THRIVE team will be using MDS information in multiple ways. It will be used to inform the quality of care for residents, how it varies across participating sites, and how it changes over time. This information also will allow us to “control” for resident differences so we can better understand similarities and differences in care provision that are not related to differences in the resident population. In this way, the MDS is a powerful tool to help us all understand and predict the care needs of the people served in nursing homes.
Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).