Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare

OBJECTIVE: To assess the accuracy of nursing home self‐report of major injury falls on the Minimum Data Set (MDS). DATA SOURCES: MDS assessments and Medicare claims, 2011‐2015. STUDY DESIGN/METHODS: We linked inpatient claims for major injury falls with MDS assessments. The proportion of claims‐identified falls reported for each fall‐related MDS item was calculated. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. We created a claims‐based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures. PRINCIPAL FINDINGS: We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long‐stay (62.9 percent) than short‐stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). Adjusting for facility‐level race differences, reporting was lower for nonwhite people than white people; holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. The correlation between fall rates based on claims vs the MDS was 0.22. CONCLUSIONS: The nursing home‐reported data used for the NHC falls measure may be highly inaccurate.