Combining Items From 3 Federally Mandated Assessments Using Rasch Measurement to Reliably Measure Cognition Across Postacute Care Settings

Objective: To combine items from the Functional Independence Measure, Minimum Data Set (MDS) 2.0, and the Outcome and Assessment Information Set (OASIS)-B to reliably measure cognition across postacute care settings and facilitate future studies of patient cognitive recovery. Design: Rasch analysis of data from a prospective, observational cohort study. Setting: Postacute care inclusive of inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. Participants: Patients (NZ147) receiving rehabilitation services. Interventions: Not applicable. Main Outcome Measures: Functional Independence Measure, MDS 2.0, and the OASIS-B. Results: Six cognition items demonstrated good construct validity with no misfitting items, unidimensionality, good precision (person separation reliability, 0.95), and an item hierarchy that reflected a clinically meaningful continuum of cognitive challenge. Conclusions: This is the first attempt to combine the cognition items from the 3 historically, federally mandated assessments to create a common metric for cognition. These 6 items could be adopted as standardized patient assessment data elements to improve cognitive assessment across postacute care settings. Archives of Physical Medicine and Rehabilitation 2021;102:106-14 (c) 2020 by the American Congress of Rehabilitation Medicine