The Residential History File: Studying Nursing Home Residents' Long-Term Care Histories*

Center for Gerontology and Health Care Research, Brown University, PO Box G-S121-6, Providence, RI 02912, USA.
Health Services Research (Impact Factor: 2.78). 10/2010; 46(1 Pt 1):120-37. DOI: 10.1111/j.1475-6773.2010.01194.x
Source: PubMed


To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays.
Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006.
The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death. The identification of residents in NHs is compared with the reports in OSCAR and part B claims.
The RHF correctly identified 84.8 percent of part B claims with place-of-service in NH, and it identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5 percent non-Medicare NH decedents were transferred to the hospital to die versus 45.6 percent skilled nursing facility decedents.
The population-based design of the RHF makes it possible to conduct policy-relevant research to examine the variation in the rate and type of health care transitions across the United States.

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Available from: Susan C Miller, Mar 11, 2014
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    • "Data for these analyses come from three individual - level datasets : the nursing home Resident Assessment Instrument Minimum Data Set ( MDS ) , Medicare Part A claims ( for hospital and SNF care ) , and Medicare enrollment data . Applying the Residential History File ( RHF ) methodology ( Intrator et al . 2011 ) , we concatenate MDS assessments and Medicare claims into individual beneficiary histories that allow us to track individuals ' daily medical service utilization . Additionally , we matched these data to zip - code - level census aggregates for the year 2000 ."
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    ABSTRACT: Objective To examine outcomes associated with dual eligibility (Medicare and Medicaid) of patients who are admitted to skilled nursing facility (SNF) care and whether differences in outcomes are related to states' Medicaid long-term care policies.Data Sources/CollectionWe used national Medicare enrollment data and claims, and the Minimum Data Set for 890,922 community-residing Medicare fee-for-service beneficiaries who were discharged to an SNF from a general hospital between July 2008 and June 2009.Study DesignWe estimated the effect of dual eligibility on the likelihood of 30-day rehospitalization, becoming a long-stay nursing home resident, and 180-day survival while controlling for clinical, demographic, socio-economic, residential neighborhood characteristics, and SNF-fixed effects. We estimated the differences in outcomes by dual eligibility status separately for each state and showed their relationship with state policies: the average Medicaid payment rate; presence of nursing home certificate-of-need (CON) laws; and Medicaid home and community-based services (HCBS) spending.Principal FindingsDual-eligible patients are equally likely to experience 30-day rehospitalization, 12 percentage points more likely to become long-stay residents, and 2 percentage points more likely to survive 180 days compared to Medicare-only patients. This longer survival can be attributed to longer nursing home length of stay. While higher HCBS spending reduces the length-of-stay gap without affecting the survival gap, presence of CON laws reduces both the length-of-stay and survival gaps.Conclusions Dual eligibles utilize more SNF care and experience higher survival rates than comparable Medicare-only patients. Higher HCBS spending may reduce the longer SNF length of stay of dual eligibles without increasing mortality and may save money for both Medicare and Medicaid.
    Full-text · Article · Jul 2014 · Health Services Research
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    • "Applying the Residential History File methodology (Intrator et al. 2011), which concatenates MDS assessment and Medicare claims into individual beneficiary trajectories, we identified all Medicare fee-for-service (FFS) beneficiaries who were discharged directly from an acute general hospital to a SNF for postacute care between January 1, 2004 and December 31, 2006. We excluded prior nursing home residents because they would be frailer than PAC patients from the community and because prior nursing home residence would systematically affect the next PAC choice. "
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    ABSTRACT: To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage. We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006. We examined the relationship between the proportion of discharges from a hospital and alternative SNFs on the rehospitalization of patients treated by that hospital-SNF pair using an instrumental variable approach. We used distances to alternative SNFs from residence of the patients of the originating hospital as the instrument. Our estimates suggest that if the proportion of a hospital's discharges to an SNF was to increase by 10 percentage points, the likelihood of patients treated by that hospital-SNF pair to be rehospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge. Stronger hospital-SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients' outcomes postdischarge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNFs.
    Full-text · Article · Oct 2013 · Health Services Research
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    • "a product of the Shaping Long-Term Care in America Project being conducted at the Brown University Center for Gerontology and Healthcare Research and supported , in part, by the National Institute on Aging ( This dataset includes information for years 2000–2009 and combines variables from the Online Survey Certification and Reporting (OSCAR) data (administrative data collected by state survey agencies during nursing facility annual certification inspections); the Minimum Data Set (MDS) (resident-level data related to resident clinical and functional status); the Area Resource File (ARF) (a national county-level health resources database maintained by the Health Resources and Services Administration that contains data about the health professionals and facilities in each county); and the Residential History File, a data resource developed at the Brown University Center for Gerontology and Healthcare Research built using Medicare Enrollment data, Medicare claims data, and MDS data to track individuals as they move through the long-term care system (Intrator et al. 2011). "
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    ABSTRACT: Programs that help older adults live independently in the community can also deliver net savings to states on the costs of long-term supports and services. We estimate that if all states had increased by 1 percent the number of adults age sixty-five or older who received home-delivered meals in 2009 under Title III of the Older Americans Act, total annual savings to states' Medicaid programs could have exceeded $109 million. The projected savings primarily reflect decreased Medicaid spending for an estimated 1,722 older adults with low care needs who would no longer require nursing home care-instead, they could remain at home, sustained by home-delivered meals. Twenty-six states could have realized net savings in 2009 from the expansion of their home-delivered meals programs, while twenty-two states would have incurred net costs. Programs such as home-delivered meals have the potential to provide substantial savings to some states' Medicaid programs.
    Full-text · Article · Oct 2013 · Health Affairs
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