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Measuring Health Outcomes for Older People Using the Sage Database

  • Giovanni Gambassi (a1), Kate L. Lapane (a2), Antonio Sgadari (a1), Francesco Landi (a1), Vincent Mor (a2) and Roberto Bernabei (a1)...

Abstract

We establish the potential for outcomes evaluation of a long-term care population-based dataset. Data come from the Health Care Financing Administration's case-mix and quality demonstration project including all Medicare/ Medicaid certified homes of five U.S. states during 1992–1994. Using the Minimum Data Set, we identified nearly 70,000 residents over 65 years of age with congestive heart failure. We provide a preliminary analysis of pharmacotherapy of congestive heart failure and its effects on decline in physical functioning. Functional outcome, expressed as the rate of ADL decline, was improved for patients on combination therapy relative to those on digoxin or ACE-inhibitors alone. The availability of a population-based data set provides a means of evaluating current policies and practices.

Cet article cherche à établir le potentiel d'évaluation des programmes d'une base de données sur les soins de longue durée dans la communauté. Les données proviennent d'un projet-pilote sur la qualité et la clientèle du Health Care Financing Administration, incluant tous les établissements couverts par Medicare/ Medicaid de cinq états américains entre 1992 et 1994. À l'aide du Minimum Data Set, 70 000 résidents de plus de 65 ans souffrant d'insuffisance cardiaque globale ont été identifiés. L'analyse préliminaire de la pharmacothérapie de l'insuffisance cardiaque globale et de ses effets sur le déclin des fonctions physiques est présentée. L'état des fonctions physiques, mesuré par le taux de déclin des activités instrumentales de la vie quotidienne des patients qui suivent une thérapie combinée s'améliore par rapport à ceux qui prennent seulement de la digoxine ou des inhibiteurs de l'enzyme convertissant l'angiotensine. La disponibilité d'un ensemble de donnees sur la population fournit done une méthode d'évaluation des politiques et des pratiques courantes.

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1.Greengross, S, Murphy, E, Quam, L, Rochon, P. Aging: a subject that must be at the top of world agendas. BMJ 1997;315:1028–9.
2.Avorn, J. Medication use and the elderly: current status and opportunities. Health Affairs Spring 1995;276–86.
3.Sackett, DL, Rosenberg, WMC, Gray, JAM, Haynes, RB, Richardson, WS. Evidence based medicine: what it is and what it isn't. It's about integrating individual clinical expertise and the best external evidence. BMJ 1996;312:71–2.
4.Sibbald, B, Roland, M. Why are randomised controlled trials important? BMJ 1998;316:201.
5.Evidence-Based Medicine Working Group. Evidence-Based Medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420–5.
6.Levin, A. Evidence-based medicine gaining supporters. Ann Intern Med 1998;128:334–6.
7.Charlton, BG. Randomized clinical trials: the worst kind of epidemiology? Nature Medicine 1995;1:1101–2.
8.Taubes, G. Looking for the evidence in medicine. Science 1996;272:22–4.
9.Feinstein, AR, Horwitz, RI. Problems in the evidence of evidence-based medicine. Am J Med 1997;103:529–35.
10.Maynard, A. Evidence-based medicine: an incomplete method for informing treatment choices. Lancet 1997;349:126–8.
11.Kerridge, I, Lowe, M, Henry, D. Ethics and evidence based medicine. BMJ 1998;316:1151–3.
12.Naylor, CD. Grey zone of clinical practice: some limits to evidence-based medicine. Lancet 1995;345:840–2.
13.Knottnerus, JA, Dinant, GJ. Medicine based evidence, a prerequisite for evidence based medicine. BMJ 1997;315:1109–10.
14.Schneider, LS, Olin, JT, Lyness, SZ, Chui, HC. Eligibility of Alzheimer's disease clinic patients for clinical trials. J Am Geriatr Soc 1997;45:923–8.
15.Green, J, Britten, N. Qualitative research and evidence based medicine. BMJ 1998;316:1230–2.
16.Gurwitz, JH, Col, NF, Avorn, J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992;268:1417–22.
17.Avorn, J. Including elderly people in clinical trials, BMJ 1997;315:1033–4.
18.Bugeja, G, Kumar, A, Banerjee, AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997;315:1059.
19.Lye, M. Access to advances in cardiology. Lancet 1997;350:1162–3.
20.Evans, JG. Evidence-based and evidence-biased medicine. Age-Ageing 1995;24:461–3.
21.Black, N. Developing high quality clinical databases: the key to a new research paradigm. BMJ 1997;315:381–2.
22.Hornberger, J, Wrone, E. When to base clinical policies on observational versus randomized trial data. Ann intern Med 1997;127:697703.
23.Horwitz, RI, Viscoli, CM, Clemens, JD, Sadock, RT. Developing improved observational methods for evaluating therapeutic effectiveness. Am J Med 1990;89:630–8.
24.Black, N. Why we need observational studies to evaluate the effectiveness of health care. BMJ 1996;312:1215–8.
25.Walker, AM. Common language. Pharmacoepidemiol Drug Safety 1996;5:415–8.
26.Engels, EA, Spitz, MR. PACE-setting research. Lancet 1997;350:677–8.
27.Beers, MH, Ouslander, JG, Fingold, SG, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med 1992;117:684–9.
28.Willcox, SM, Himmelstein, DU, Woolhandler, S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994;272:292–6.
29.Rubenstein, LZ. An overview of comprehensive geriatric assessment: rationale, history, program models, basic components. In: Rubenstein, LZ, Wieland, D, Bernabei, R, eds. Geriatric assessment technology: the state of the art. Milano, Italia: Kurtis; 1995:1126.
30.Avorn, J, Gurwitz, JH. Drug use in the nursing home. Ann Intern Med 1995;123:195204.
31.Beers, MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:1531–6.
32.Bernabei, R, Gambassi, G, Mor, V. The SAGE database: introducing functional outcomes in geriatric pharmaco-epidemiology. J Am Geriatr Soc 1998;46:250–2.
33.Bernabei, R, Gambassi, G, Lapane, K, et al. Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. J Gerontol Med Sci 1999;54:M2533.
34.Morris, JN, Hawes, C, Fries, BE et al. Designing the national resident assessment instrument for nursing homes. Gerontologist 1990;30:293–7.
35.Gambassi, G, Landi, F, Peng, L, et al. Validity of diagnostic and drug data in standardized nursing home resident assessments: potential for geriatric pharmacoepidemiology. Med Care 1998;36:167–79.
36.Bernabei, R, Gambassi, G, Lapane, K, et al. Management of pain in elderly cancer patients. JAMA 1998;279:1877–82.
37.Gambassi, G, Lapane, K, Sgadari, A, et al. Prevalence, clinical correlates and treatment of hypertension in institutionalized elderly. Arch Intern Med 1998;158:2377–85.
38.Landi, F, Gambassi, G, Lapane, K, et al. Comorbidity and drug use in cognitively impaired elderly living in long-term care. Dement Geriatr Cogn Disord 1998;9:347–56.
39.Minimum Data Set Plus Training Manual. Natick, MA: Eliot Press; 1991.
40.Hawes, C, Morris, JN, Phillips, CD, Mor, V, Fries, BE, Nonemaker, S. Reliability estimates for the Minimum Data Set for Nursing Home Resident Assessment and care screening (MDS) Gerontologist 1995; 2:172–8.
41.Morris, JN, Nonemaker, S, Murphy, K, et al. A commitment to change: revision of the HCFA's RAI. J Am Geriatr Soc 1997;45:1011–6.
42.Sgadari, A, Morris, JN, Fries, BE, et al. Effort to establish the reliability of the RAI. Age Ageing 1997;26:2730.
43.Hawes, C, Phillips, CD, Mor, V, et al. The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality. J Am Geriatr Soc 1997;45:977–85.
44.Fries, BE, Hawes, C, Morris, JN, Phillips, CD, Mor, V, Park, PS. Effect of the national Resident Assessment Instrument on selected health conditions and problems. J Am Geriatr Soc 1997;45:9941001.
45.Mor, V, Intrator, O, Fries, BE, et al. Changes in hospitalization associated with introducing the resident assessment instrument. J Am Geriatr Soc 1997;45:1002–10.
46.Phillips, C, Morris, JN, Hawes, C, et al. Association of the Resident Assessment Instrument (RAI) with changes in function, cognition, and psychosocial status. J Am Geriatr Soc 1997;45:986–93.
47.Morris, JN, Fries, BE, Mehr, DR et al. MDS Cognitive Performance Scale. J Gerontol 1994;49:M17482.
48.Mor, V, Branco, K, Fleishman, J, et al. The structure of social engagement among nursing home residents. J Gerontol 1995;50B:P18.
49.Voelkl, JE, Fries, BE, Galecki, AT. Predictors of nursing home resident's participation in activity programs. Gerontologist 1995;35:4451.
50.Blaum, CS, O'Neill, EF, Clements, KM, Fries, BE, Fiatarone, MA. Validity of the Minimum Data Set for assessing nutritional status in nursing home residents. Am J Clin Nutr 1997;66:787–94.
51.Williams, BC, Li, Y, Fries, BE, Warren, RL. Predicting patient scores between the Functional Independence measure and the Minimum Data Set: development and performance of a FIM-MDS “crosswalk”. Arch Phys Med Rehabil 1997;78:4854.
52.Resnick, HE, Fries, BE, Verbrugge, LM. Windows to their world: the effect of sensory impariments on social engagement and activity time in nursing home residents. J Gerontol Soc Sci 1997;52:S135–44.
53.Resnick, NM, Brandeis, GH, Baumann, MM, Morris, JN. Evaluating a national assessment strategy for urinary incontinence in nursing home residents: reliability of the Minimum Data Set and validity of the Resident Assessment Protocol. Neurourol Urodyn 1996;15:583–98.
54.Fried, TR, Mor, V. Frailty and hospitalization of long-term stay nursing home residents. J Am Geriatr Soc 1997;45:265–9.
55.Hartmaier, SL, Sloane, PD, Guess, HA, Koch, GG. The MDS cognition scale: a valid instrument for identifying and staging nursing home residents with dementia using the Minimum Data Set. J Am Geriatr Soc 1994;42:1173–9.
56.Hartmaier, SL, Sloane, PD, Guess, HA, Koch, GG, Mitchell, CM, Phillips, CD. Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination. J Gerontol Med Sci 1995;50:M12833.
57.Frederiksen, K, Tariot, P, De, Jonghe E. Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc 1996;44:305–9.
58.Fries, BE, Schneider, DP, Foley, WJ, Gavazzi, M, Burke, R, Cornelius, E. Refining a case-mix measure for nursing homes: resource utilization groups (RUG-III). Med Care 1994;32:668–85.
59.Fries, BE, Mehr, DR, Schneider, D, Foley, WJ, Burke, R. Mental dysfunction and resource use in nursing homes. Med Care 1993;31:898920.
60.Master Drug Data Base (MDDB) Documentation manual. Indianapolis, IN: MediSpan Inc.; 1995.
61.Massachussets Extended Care Federation Survey, Certification and Enforcement. The Long-Term Care Survey Regulations, Forms, Intepretative Guidelines. Dedham, MA, 1995.
62.Zinn, JS, Mor, V. Nursing home special care units: distribution by type, state and facility characteristics. Gerontologist 1994;34:371–7.
63.Banaszak-Holl, J, Zinn, JS, Mor, VThe impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective. Health Serv Res 1996;31:97117.
64.Stambler, H. The Area Resource File: a brief look. Public Health Reports 1988;103:184–8.
65.Stafford, RS, Saglam, D, Blumenthal, D. National patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure. Arch Intern Med 1997;157:2460–4.
66.McDermott, MM, Feinglass, J, Lee, P, et al. Heart failure between 1986 and 1994: temporal trends in drug-prescribing practices, hospital readmissions, and survival at an academic medical center. Am Heart J 1997;134:901–9.
67.Rich, MW, Brooks, K, Luther, P. Temporal trends in pharmacotherapy for congestive heart failure at an academic medical center: 1990–1995. Am Heart J 1998:135:367–72.
68.The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987;316:1429–35.
69.SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293302.
70.Garg, R, Yusuf, S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995:273:1450–6.
71.Newman, J, Ahmed, O, Hyngstrom, T, et al. Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized Medicare patients in 10 large states. Arch Intern Med 1997;157:1103–8.
72.Deedwania, PC. Underutilization of evidence-based therapy in heart failure. An opportunity to deal a winning hand with ace up your sleeve. Arch Intern Med 1997;157:2409–12.
73.Wennberg, JE, Freeman, JL, Shelton, RM, et al. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med 1989:321:1168–73.
74.Wennberg, JE. The geography of health care in the United States. In: Wennberg, JE, McAndrew, Cooper M, eds. The Dartmouth atlas of health care. Chicago, IL: American Hospital Publishing, Inc.; 1996:1135.
75.Philbin, EF, Andreaou, C, Rocco, TA, Lynch, LJ, Baker, SL. Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996;77:832–8.
76.Raleigh, VS. The demographic timebomb. BMJ 1997;315:442–3.
77.Redelmeier, DA, Tan, SH, Booth, GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 1998;338:1516–20.
78.Kane, RL. Improving the quality of long-term care. JAMA 1995;273:1376–80.
79.Institute of Medicine. Health outcomes for older people. JC, Feasley, ed. Washington DC: National Academic Press, 1996.
80.Epstein, RS, Sherwood, LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med 1996;124:832–7.
81.Hunter, DJ, Fairfield. Disease management. BMJ 1997;314:50–3.
82.Phillips, CD, Sloane, PD, Hawes, C, et al. Effects of residence in Alzheimer disease special care units on functional outcomes. JAMA 1997;278:1340–4.
83.Zimmerman, DR, Karon, SL, Arling, G, et al. Developing and testing of nursing home quality indicators. Health Care Financing Review 1995;16(4):107–27.
84.Berlowitz, DR, Brandeis, GH, Moskowitz, MA. Using administrative databases to evaluate long-term care. J Am Geriatr Soc 1997;45:618–23.
85.Bradley, EH, Besdine, R. Outcomes-based quality improvement: reducing the data collection burden. J Am Geriatr Soc 1998;46:534–5.
86.Teresi, JA, Holmes, D. Should MDS data be used for research? Gerontologist 1992;32:148–9.
87.Ouslander, JG. Maximizing the Minimum Data Set. J Am Geriatr Soc 1994;42:1212–3.
88.Black, D, Bowman, C. Community institutional care for frail elderly people. BMJ 1997;315:441–2.
89.Schroll, M. Effects of systematic geriatric assessment. Lancet 1997;350:604–5.
90.Steel, K. Research on aging: an agenda for all nations individually and collectively. JAMA 1997;278:1374–5.
91.Fries, BE, Schroll, M, Hawes, C, Gilgen, R, Jonsson, PV, Park, P. Approaching cross-national comparisons of nursing home residents. Age Ageing 1997;26(suppl. 2):13–8.
92.Phillips, CD, Hawes, C, Mor, V, Fries, BE, Morris, JN, Nennstiel, ME. Facility and area variation affecting the use of physical restraints in nursing homes. Med Care 1996;34:1149–62.
93.Gatsonis, CA, Epstein, AM, Newhouse, JP, Normand, SL, McNeil, BJ. Variations in the utilization of coronary angiography for elderly patients with an acute myocardial infarction. Med Care 1995;33:625–42.

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