USE OF THE MINIMUM DATA SET TO RATE INCONTINENCE SEVERITY

OBJECTIVES: To assess the relationship of the MDS incontinence severit y ratings to direct measures of incontinence frequency. DESIGN: Two me thods of measuring incontinence were compared: the MDS rating as recor ded by nursing home (NH) staff and physical checks for wetness perform ed by research staff. SETTING AND PARTICIPANTS: A total sample of 293 older residents from nine nursing homes located in Iowa, the State of Washington, and the Los Angeles area were assessed once. A subsample o f 49 incontinent residents were assessed twice, before and after the i mplementation of a prompted voiding program. INTERVENTION: This study is a part of a larger study evaluating the use of a computer-aided inc ontinence management system (IMS). Incontinent residents were assessed , and, if they met predefined criteria, they were treated with prompte d voiding. MEASUREMENTS: Three measures of incontinence were used: the MDS rating recorded by NH staff, physical checks for wetness performe d by NH staff while assessing residents for and treating them with pro mpted voiding, and physical checks for wetness performed independently by research staff. RESULTS: There was a statistically significant cor relation (r = .49; P less than or equal to .001) between research staf f wet checks and the MDS ratings, but wetness checks performed by NH s taff had an insignificant correlation with MDS ratings (r = .003; P < 0.984). There was wide variability within and between NHs in the corre lation. For residents who were placed on the prompted voiding program, the pre to post wet rate, as measured by research staff, improved sig nificantly (from 28 to 14%; t = 6.73; df = 48; P < .001), whereas the pre to post MDS ratings did not change significantly (from 1.7 to 2.0; t = -1.42; df = 48; P < .075). CONCLUSIONS: Although the MDS appears to identify incontinent NH residents accurately, its clinical utility may be limited by disagreements between actual wet check data and MDS categorical severity rankings for residents known to be incontinent. T he wide variability between direct observational measures of wetness a nd the MDS scores denoting incontinence severity we observed may limit the potential usefulness of the MDS for detecting changes in incontin ence severity. It is possible that more information and instructions a re needed for staff completing the MDS if the goal is to discriminate between different levels of incontinence severity and measure changes over time in response to therapeutic interventions.