LTCPR-falls-BDZ - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Benzodiazepines: Percentage of residents aged 66 and older who were prescribed a benzodiazepine

Alternate Name

Benzodiazepines: Percentage of residents aged 66 and older who were prescribed a benzodiazepine

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of Long-Term Care residents who have at least one benzodiazepine medication dispensed in the reporting period.

Indicator Status

Developmental

HQO Reporting tool/product

Personalized/Custom Reports (includes Practice Reports)

Dimension

Patient-centred

Type

Outcome

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

The number of residents with at least one benzodiazepine dispensed is divided by the total number of residents who are at least 66 years old, not new to the Long-Term Care home, and are not in palliative care. This is multiplied by 100.

Numerator including inclusion/exclusion

The total number of residents who have at least one record for a benzodiazepine drug with an Long-Term Care flag in the 90 days prior to and including the index date (a resident’s last service date in the quarter).

Inclusions:
1. Includes residents with at least one oral benzodiazepine medication dispensed in the reporting period.
2. Medication must be dispensed in Long-Term Care (i.e. have the Long-Term Care flag in the data)

Denominator including inclusion/exclusion

The total number of residents in the cohort for the reporting period who are aged 66 years and older, were not new to the Long-Term Care home, and were not in palliative care.

Cohort Inclusions:

To be included in the OHIP/ODB cohort a resident must have any combination of two records from the Ontario Health Insurance Plan or Ontario Drug Benefit databases. The OHIP records are for services provided in LTC; the ODB claims must have the LTC flag.
Valid ICES key number.
Ontario Resident at index date.
Adults aged less than 115 years at index date.
Death date less than seven days before index date.
Institute type must be a nursing home (NH) or home for the aged (HF)
Resident must be linked to a physician referred to as Most Responsible Physician.

Exclusions:

Age 65 or less on index date
Residents with palliative care in past six months
Residents new to their LTC home (less than 100 days in home).
Residents in a physician’s group with five or fewer residents within the LTC home (apply this exclusion ONLY when stratifying rates by physician)

Adjustment (risk, age/sex standardization)- detailed

None.

Data Source

Discharge Abstract Database (DAD), Ontario Drug Benefit (ODB), Ontario Health Insurance Plan (OHIP) Claims History Database, Ontario Mental Health Reporting System (OMHRS), Physician Database (IPDB), Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

OTHER RELEVANT INFORMATION

Caveats and Limitations

Due to data limitations, this indicator includes medications dispensed that are prescribed on an as-needed basis (PRN). Caveats: These indicators are not intended to assess the appropriateness of the use of these medications. They are designed to identify those residents at increased risk of falls related to the medications, and to aid with quality improvement. For this reason, residents who may have clinical indications for these medications are included in the indicator because these residents would be at an increased risk of falls. Where appropriate, residents may be considered for a trial of weaning, titrating drug dose, or a trial of substituting with a medication that has a lower risk of falls. These indicators are not intended to override clinical judgement, but solely to capture those who may be at an increased risk of falls.