title: Validity of the RAI-MDS for ascertaining diabetes and comorbid conditions in long-term care facility residents.
abstract: BACKGROUND
  This study assessed the validity of the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0 for diagnoses of diabetes and comorbid conditions in residents of long-term care facilities (LTCFs).
  
  
  METHODS
  Hospital inpatient, outpatient physician billing, RAI-MDS, and population registry data for 1997 to 2011 from Saskatchewan, Canada were used to ascertain cases of diabetes and 12 comorbid conditions. Prevalence estimates were calculated for both RAI-MDS and administrative health data. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated using population-based administrative health data as the validation data source. Cohen's κ was used to estimate agreement between the two data sources.
  
  
  RESULTS
  23,217 LTCF residents were in the diabetes case ascertainment cohort. Diabetes prevalence was 25.3% in administrative health data and 21.9% in RAI-MDS data. Overall sensitivity of a RAI-MDS diabetes diagnoses was 0.79 (95% CI: 0.79, 0.80) and the PPV was 0.92 (95% CI: 0.91, 0.92), when compared to administrative health data. Sensitivity of the RAI-MDS for ascertaining comorbid conditions ranged from 0.21 for osteoporosis to 0.92 for multiple sclerosis; specificity was high for most conditions.
  
  
  CONCLUSIONS
  RAI-MDS clinical assessment data are sensitive to ascertain diabetes cases in LTCF populations when compared to administrative health data. For many comorbid conditions, RAI-MDS data have low validity when compared to administrative data. Risk-adjustment measures based on these comorbidities might not produce consistent results for RAI-MDS and administrative health data, which could affect the conclusions of studies about health outcomes and quality of care across facilities.
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada. lisa.lix@med.umanitoba.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.forename: Lin
authors.initials: L
authors.lastname: Yan
authors.forename: David
authors.initials: D
authors.lastname: Blackburn
authors.forename: Nianping
authors.initials: N
authors.lastname: Hu
authors.forename: Verena
authors.initials: V
authors.lastname: Schneider-Lindner
authors.forename: Gary F
authors.initials: GF
authors.lastname: Teare
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012525:Saskatchewan / Q000453:epidemiology; D012680:Sensitivity and Specificity