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A Methodology to Identify a Cohort of Medicare Beneficiaries Residing in Large Assisted Living Facilities Using Administrative Data

Thomas, Kali S., MA, PhD*,†; Dosa, David, MD, MPH*,†; Gozalo, Pedro L., MSc, PhD*; Grabowski, David C., PhD; Nazareno, Jennifer, PhD*; Makineni, Rajesh, MS*; Mor, Vincent, PhD*,†

doi: 10.1097/MLR.0000000000000659
Online Article: Applied Methods

Background: Assisted living is a popular option for housing and long-term care.

Objective: To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs).

Research Design: We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and addresses of 11,751 ALFs. Using this finder file, we identified 738,567 beneficiaries residing in validated ALF ZIP codes in 2007–2009. We compared characteristics of this cohort to those of ALF residents in the National Survey of Residential Care Facilities (n=3009), a sample of community-dwelling Medicare beneficiaries (n=33,025,690), and long-stay nursing home residents (n=1,287,572).

Data Sources: A national list of licensed ALFs, Medicare enrollment records, and administrative health care databases.

Results: The ALF cohort we identified had good construct validity based on their demographic characteristics, health, and health care utilization when compared with ALF residents in the National Survey of Residential Care Facilities, community-dwelling Medicare beneficiaries, and long-stay nursing home residents.

Conclusions: Our finder file of 9-digit ZIP codes enables identification of ALF residents using administrative data. This approach will allow researchers to examine questions related to the quality of care, health care utilization, and outcomes of residents in this growing sector of long-term care.

*Brown University School of Public Health

Department of Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, RI

Department of Health Care Policy, Harvard Medical School, Boston, MA

Supported by the National Institute on Aging (#R21AG047303), the Agency for Healthcare Research and Quality (T32 HS-000011 to JN), and by a US Department of Veterans Affairs Veterans Integrated Service Network (VISN) 1 Career Development Award (V1CDA2014-27 to KST).

V.M. is a founder and on the board of directors of PointRight Inc., an information services company serving nursing homes on quality measurement and improvement. V.M. is also a stock holder for PointRight Inc. and Navi Health. V.M. is the Chair of the Independent Advisory Committee on Quality for HCR ManorCare. V.M. receives no research funding, data, or consultation on his research from PointRight or Navi Health. V.M. also received honoraria from the Alliance for Health Care Quality. J.N. is a co-owner of an assisted living facility in California. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The remaining authors declare no conflict of interest.

Reprints: Kali S. Thomas, MA, PhD, Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912. E-mail:

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