When a resident is preparing to leave a skilled nursing facility, healthcare professionals use something called the Discharge Function Score to gauge how well they’ll manage on their own. This score is crucial because it helps determine the level of support or care the resident might need after they leave. But how exactly is this score calculated? Let’s break it down in simple terms.
What is the Discharge Function Score?
The Discharge Function Score is a measure of a resident’s ability to handle daily activities and functions independently once they leave the facility. It combines various assessments of their physical, mental, and daily living skills into one comprehensive number using covariates (factors or variables that can influence outcomes) to calculate coefficients and impute values where necessary.
Considerations for how the score is calculated
- Understanding Covariates: Covariates are like pieces of a puzzle that help us understand how well someone is doing before they leave a skilled nursing facility (SNF). These pieces include things like age, health conditions, and how they were able to move around when they first arrived at the SNF.
- Calculating Coefficients: Coefficients are numbers that show how much each piece of the puzzle (each covariate) affects a person's expected progress. For example, if someone is older or had more difficulty moving around at the start, these coefficients help us predict how much their abilities might improve by the time they leave the SNF.
- Imputing Values: Sometimes, we might be missing a piece of the puzzle — maybe we don't have all the information about someone's health or abilities. Imputation fills in these missing pieces by estimating values based on a statistical model. It's like completing a partially finished puzzle by looking at similar pieces around it.
- Putting It All Together: The Discharge Function Score uses these covariates, coefficients, and imputed values to predict how well residents are expected to be doing when they leave the SNF. It helps us understand their progress and make sure they're getting the right care and support to improve as much as possible before they go home or move to another place.
A step-by-step guide on how the score is determined:
1. Collect MDS Data
The MDS assessment collects detailed information about a resident’s abilities in several key areas:
- Mobility: How well they can move around.
- Self-Care: Their ability to perform daily activities, like bathing and dressing.
- Cognitive Function: Their memory and decision-making abilities.
- Covariates: Covariates help us understand things like age, health conditions, and how they were able to move around when they first arrived at the SNF.
2. Handle Missing Data through Regression Imputation
If any Self-Care or Mobility MDS items are missing, regression imputation is used to estimate the missing values. Imputation involves replacing missing data with estimated values based on other available information using a statistical model based on other data.
3. Apply Coefficients to MDS Values and Calculate Weighted Scores
Each MDS value is assigned a coefficient, which is a number that reflects how important that item is in predicting overall functioning. For example, if the mobility score is considered very important, it might have a higher coefficient. Once you have the MDS values (whether actual or imputed), multiply each one by its coefficient to get a weighted score.
- Example Calculation:
- Mobility: Imputed score = 3, Coefficient = 2 → Weighted Mobility Score = 3 × 2 = 6
- Self-Care: Actual score = 4, Coefficient = 3 → Weighted Self-Care Score = 4 × 3 = 12
- Cognition: Actual score = 5, Coefficient = 1.5 → Weighted Cognition Score = 5 × 1.5 = 7.5
4. Sum the Weighted Scores
Add up all the weighted scores to get the total Discharge Function Score. This total score reflects the resident’s overall ability to function independently.
- Example:
- Weighted Mobility Score = 6
- Weighted Self-Care Score = 12
- Weighted Cognition Score = 7.5
- Total Discharge Function Score = 6 + 12 + 7.5 = 25.5
5. Risk Adjustment
Lastly, scores are risk adjusted. Risk adjustment is a way to make fair comparisons by considering patients' different health conditions and abilities when they enter the SNF. Not all patients start at the same level of health or ability. Some might be healthier or more mobile, while others might have more severe health issues or disabilities. Risk adjustment ensures that the differences in patient outcomes are due to the quality of care provided, not just because some patients were healthier to begin with.
Scores are risk adjusted by comparing the initial assessment values and corresponding covariates to calculate an expected improvement level, which is then compared to the actual improvement level at discharge. The actual scores are adjusted based on the expected improvement. This way, a patient with severe health issues that shows significant improvement is recognized as a strong outcome, even if their final ability level is not as high as that of a healthier patient.
Why is this important?
The Discharge Function Score helps plan for the resident’s future needs. A higher score generally indicates that the resident is more likely to manage well on their own, while a lower score suggests they may need additional support or care.
In summary, calculating the Discharge Function Score involves assessing various aspects of a resident’s abilities, handling missing data with imputation, applying coefficients to measure importance, and summing up the weighted scores. This process ensures a comprehensive and accurate picture of how well the resident will function independently after leaving the facility.
Understanding this process helps everyone involved make better decisions about post-discharge care and support.
Where SHP can help
IntelliLogix™, SHP’s solution for skilled nursing facilities, includes extensive tools and reports to help manage performance and quality. Below are a few key areas where data pertaining to the Discharge Function Score is represented.
- MDS Scrubber Quality Alerts – informational alerts that proactively calculate DFS and notify you about score discrepancies and critical patient updates
- Quality Measure and QRP Reports – provides numerator and denominator data with resident drill down to see coded and imputed values (QRP Report) and comparison to expected score and triggering criteria.
- 5 Star Measures – DFS part of the Short Stay measures. Worth noting - for QRP measures, the data collection period is two quarters behind the MDS measures.
- QRP Active Resident Functional Review Report – provides information related to admission performance and expected scores for active residents currently on case load, so users can evaluate current performance and outcomes related to implemented interventions and gauge potential to meet expected scores prior to discharge.
If you are not already an SHP customer and would like to better understand how the Discharge Function Score impacts your SNF, schedule a free demo with a team member here.
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