MDS 3.0: can this release be all things to all people?

The 4-part presentation of the Minimum Data Set (MDS) 3.0 by Saliba and colleagues1e4 redefines how we think about residents in the nursing home and how we document their needs. The MDS 3.0 brings significant improvements to the previous version, and harmoniously makes an attempt to be all things to all people. It is a monumental effort. It is a document to record care needs, identify diagnoses, and marshal resources when there is a change in conditions. It provides survey oversight and opportunities for quality improvement. It serves as a mechanism for reimbursement in many states. It does all of these things using the “patient’s own voice.” It is mindful of the time constraints and training of those providing direct care in the nursing home, and never loses sight of the compliance process. Nursing home reform took its current evolutionary shape in 1986 with an Institute of Medicine report entitled “Improving the Quality of Care in Nursing Homes.”5 Dr. Sidney Katz was the lead author, and when John Morley asked for an editorial, I told him someone more “officious” than I should write this piece. Unfortunately, Dr. Katz died at age 84 in 2008, but he certainly would have been proud of what has transpired. Every Institute of Medicine committee would like their report to have a grand impact. The 1986 report was a commissioned work and led to the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87). That piece of legislation laid the foundation for the MDS and Dr. Saliba and her colleagues have channeled those principles more effectively in the current rendition of the MDS. Their story is well laid out in the pages that comprise these 4 publications.1e4 It is testament to how well this project was designed and executed. Listening to the patient took a central role and even worked for the resident with advanced dementia. Despite the time constraints imposed on nursing, they were still able to create a document that is engaging and easy to use. If early reports are to be believed, this patient-centered approach is well received and allows for better care at the bedside. Surveyors still get the information they require and the research community gets a wealth of data that is more structured to analyze the processes of care in today’s nursing home. The MDS 3.0 is a remarkable piece of work for all of these reasons. The authors laid out the problems they faced, defined their processes, field tested their assumptions, and created something useful. Whole sections were redone. The first 2 articles lay out the foundation,1,2 whereas parts 3 and 4 highlight some of the innovations.3,4 The