Improving the measurement of TBI among nursing home residents

Purpose: The purpose of this project was to measure the prevalence of traumatic brain injury among nursing home residents across the country, and identify regional differences. Methods: Data were obtained from the nursing home Minimum Data Set (MDS) for the period 2000 – 2005. The MDS provides assessment data for all nursing home residents in Medicare- or Medicaid-certified nursing homes. Data are collected on a routine basis, no less than quarterly for each individual. The structure of the MDS instrument is likely to result in under-reporting of traumatic brain injury (TBI). We used a variety of approaches to increase the likelihood that TBI was recorded. Results: The approaches used to increase the prevalence of TBI had a significant impact. Prevalence rates were more than doubled from those reported by CMS. These rates were consistent with prevalence rates found by others using detailed record extraction. Conclusions: Proper treatment and support of people with TBI begins with the ability to identify the individuals. The MDS, which is used as the basis for care planning, is structured in such a way as to under-report TBI. The adoption of protocols based on our work can improve the targeting of services.