title: Impact of revisions to the F-Tag 309 surveyors' interpretive guidelines on pain management among nursing home residents.
abstract: BACKGROUND
  On 31 March 2009, the US Centers for Medicare & Medicaid Services (CMS) provided revised guidance for meeting compliance in the evaluation and management of pain in nursing home residents, known as F-Tag 309.
  
  
  OBJECTIVE
  The aim of the study was to estimate the extent to which implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain among nursing home residents.
  
  
  METHODS
  The impact of the revisions to guidance on F-Tag 309 on pain in nursing home residents was investigated. The study was quasi-experimental in design and included 174 for-profit nursing homes in 19 US states. Nursing home residents with ≥2 Minimum Data Set (MDS) assessments between 1 January 2007 and 30 March 2009 (before the revisions to the guidelines; n = 8449) and between 31 March 2009 and 31 December 2009 (after the revisions; n = 1400) were included. The MDS assessments provided information on pain, analgesic use and cognitive, functional and emotional status. Separate logistic regression models that adjusted for clustering effects of residents residing in nursing homes provided estimates of the relationship between the implementation of the revisions to F-Tag 309 and the prevalence of pain and its management.
  
  
  RESULTS
  Pain was more likely to be documented in the period after the revisions were implemented. The odds of pain being documented on at least one of two consecutive MDS assessments increased after the revisions to the guidelines were implemented (adjusted odds ratio [OR] 1.15; 95% confidence interval [CI] 1.01, 1.31). Increases in scheduled analgesic prescription were observed in the post-revision era (adjusted OR 1.38; 95% CI 1.21,1.57).
  
  
  CONCLUSIONS
  The implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain as well as analgesic use in nursing home residents with documented non-cancer pain. Use of directed language as part of the surveyors' interpretive guidelines may be a viable approach to stimulating improvements in pain documentation and management.
authors.affiliation: Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298, USA.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Quilliam
authors.forename: Wing
authors.initials: W
authors.lastname: Chow
authors.forename: Myoung S
authors.initials: MS
authors.lastname: Kim
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D014487:Centers for Medicare and Medicaid Services, U.S.; D016000:Cluster Analysis; D003071:Cognition; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D009735:Nursing Homes; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D014481:United States
chemical_list: D000700:Analgesics