Table 2. Social Information System primary data, by source¹.

Source	Data elements
LTHHCP data recorded on Patient Intake Form2 or Master Lists2	Patient's name
	Site
	Admission/discharge dates
	Social security no.
	Medicare no.
	Medicaid no.
	Food stamp
	Date of assessment
	Control no.
	Patient's name
	Medicare no.
	Medicaid no.
	Site no.
Initial DMS-1 and DMS-1+2	DMS-1 predictor score
	Qualifies for LTHHCP
	Original patient site
	Date of assessment
	Date of birth
	Marital status
	Race
	Patient's current residence location
	Patient's living arrangement:
	stairs, etc.
	live alone/with someone
	Source of income
	Home/Place where care could be provided
	Patient and family characteristics
	Measures of activities of daily living3 (ADL)
	Budget
	Assessment details:
	Patient transition
	Sources of information
	Diagnostic group
	Date of assessment
	Date of latest hospital stay
	Provider name
	Diagnoses
	Health and functional status scale scores:
	Nursing care
	Skilled nursing needs
	Functional status
	Mental status
	Impairments
	Skilled therapies required
DMS-1 reassessments Collected two times at 6-month intervals; halfway through the study year and at the end of 1 year from admission.	DMS-1 predictor score
	Current patient location
	Patient's name
	Patient's sex
	Social Security no.
	Medicare no.
	Medicaid no.
	Date of birth
	Date latest hospital stay
	Provider name
	Diagnoses
	Health and functional status scale scores:
	Nursing care
	Skilled nursing needs
	Functional status
	Mental status
	Impairments
	Skilled therapies required

¹Collected by means of patient interview, abstraction, and interpretation of patients' medical records, or the Home Assessment Abstract. Requires clinically-trained data collector.

²These are data collection forms developed especially for this evaluation project.

³ADL measures include independence in bathing, dressing, eating, toileting, transferring, and so forth.