Abstract
BackgroundPrescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include surveys, medical charts, administrative health databases, and clinical assessment records, may not collect concordant information, which can result in comparable prevalence and effect size estimates. The purpose of this research was to estimate agreement between two population-based electronic data sources for measuring use of several medication classes among LTCF residents: outpatient prescription drug administrative data and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0.MethodsPrescription drug and RAI-MDS data from the province of Saskatchewan, Canada (population 1.1 million) were linked for 2010/11 in this cross-sectional study. Agreement for anti-psychotic, anti-depressant, and anti-anxiety/hypnotic medication classes was examined using prevalence estimates, Cohen’s κ, and positive and negative agreement. Mixed-effects logistic regression models tested resident and facility characteristics associated with disagreement.ResultsThe cohort was comprised of 8,866 LTCF residents. In the RAI-MDS data, prevalence of anti-psychotics was 35.7%, while for anti-depressants it was 37.9% and for hypnotics it was 27.1%. Prevalence was similar in prescription drug data for anti-psychotics and anti-depressants, but lower for hypnotics (18.0%). Cohen’s κ ranged from 0.39 to 0.85 and was highest for the first two medication classes. Diagnosis of a mood disorder and facility affiliation was associated with disagreement for hypnotics.ConclusionsAgreement between prescription drug administrative data and RAI-MDS assessment data was influenced by the type of medication class, as well as selected patient and facility characteristics. Researchers should carefully consider the purpose of their study, whether it is to capture medication that are dispensed or medications that are currently used by residents, when selecting a data source for research on LTCF populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0023-2) contains supplementary material, which is available to authorized users.
Highlights
Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes
Given the lower levels of agreement for anti-anxiety/ hypnotic medications, we focused only on this medication when modeling the factors associated with disagreement (Table 3)
This study of agreement between medication classes captured in prescription drug administrative data and clinical assessment data from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) suggests that the medication information contained in both data sources is consistent for anti-psychotics and anti-depressants
Summary
Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information for LTCF residents include surveys, medical charts, administrative health databases, and patient clinical assessment records. Population-based sources, including administrative health databases and assessment data like the Resident Assessment Instrument Minimum Data Set (RAI-MDS) [4,5], are ideal for making cross-facility or inter-jurisdictional comparisons [6]. These data sources were not originally intended for developing facility-specific or jurisdiction-wide quality of care indicators or for studying health outcomes. Studies about the comparability of the data in administrative and clinical assessment data, including data on medication use, are important to aid decisions about which source to use in studies about LTCF residents
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