Percentage of long-term care home residents who developed a stage 2 to 4 pressure ulcer or had a pressure ulcer that worsened to a stage 2, 3 or 4

Percentage of long-term care home residents with new or worsening pressure ulcers

Percentage

The indicator is calculated using four rolling quarters of data by summing the number of residents that meet the inclusion criteria for the target quarter and each of the previous three fiscal quarters. This is done for both the numerator and denominator. The unadjusted value is the quotient of the summed numerator divided by the summed denominator, multiplied by 100 to get the percentage.

Number of long-term care home residents in the denominator who had a stage 2 to 4 pressure ulcer on their Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 target assessment and either they did not have a pressure ulcer on their prior assessment or the stage of their pressure ulcer was greater on their target assessment than on their prior assessment

Inclusions:

M2a > 1 AND (M2a - Prev_M2a) > 0 AND Prev_M2a < 4

Where,

M2a = Stage of pressure ulcer at target assessment [0-4]

Prev_M2a = Stage of pressure ulcer at prior assessment [0-4]

Number of long-term care home residents in a fiscal quarter with two valid RAI-MDS 2.0 assessments, excluding those who had a stage 4 pressure ulcer on their prior assessment

Inclusions:

Long-term care home residents with two valid resident assessments within consecutive quarters. The assessment selected as the target assessment in the current quarter must: 

• Be the latest assessment in the quarter
• Be carried out more than 92 days after the admission date
• Not be a RAI-MDS 2.0 Admission Full Assessment
• Be from a resident that had an assessment in the previous quarter
• Have 45 to 165 days between the target assessment and assessment in the previous quarter (note: If there are multiple assessments from the previous quarter that meet the time period criteria, the latest assessment is selected as the prior assessment)

Exclusions:

Residents who had a stage 4 ulcer (M2a = 4) on their prior assessment (cannot get worse)

This indicator can be risk adjusted at the individual covariate level and through direct standardization

Individual covariates:

• Resource Utilization Group (RUG)
• Late Loss Activities of Daily Living (ADL)
• Age younger than 65 years

Direct standardization:

• Case Mix Index (CMI)*

*The relative resource use compared to the overall average resource use for all Ontario long-term care home residents

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Time

This indicator includes residents who developed a new pressure ulcer (stage 2 to 4) and residents whose pressure ulcer worsened from their prior assessment. Pressure ulcers are coded for the highest stage in the last seven days from 0 (no ulcer) to 4 (ulcer reaches muscle and bone). Anecdotal evidence suggests that some assessors may not remove bandages to assess ulcers or re-stage pressure ulcers as instructed by the RAI-MDS 2.0 manual. The indicator calculation is based on the stage of pressure ulcer for the pressure ulcer at the highest stage. If a long-term care home resident develops a new pressure ulcer at a lower stage than a pressure ulcer that did not change stage since the last assessment, the new pressure ulcer would not be captured in the numerator for the calculation of this indicator. The results for this indicator include only residents in long-stay beds. Rolling four quarter averages stabilize the rates from quarter-to-quarter variations, especially for smaller facilities, but make it more difficult to detect quarterly changes. Since residents are assessed on a quarterly basis, each resident can contribute to the indicator up to four times. Risk-adjusted values are censored if the denominator is less than 30. General limitations when using RAI-MDS 2.0 data include random error, coding errors and missing values. The COVID-19 pandemic affected many long-term care homes across Ontario, including their ability to complete assessments and/or submit data. Available data may vary by jurisdiction and facility. Results should be interpreted in the context of the COVID-19 pandemic.

Data are based on information from the mandatory Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 assessment. The RAI-MDS 2.0 is a standardized assessment that is completed for each resident upon admission to a long-term care home and quarterly thereafter, by the resident’s care team, by reviewing the resident’s medical records and speaking to the resident and their family. Legacy agency Health Quality Ontario (HQO) used an evidence-informed process and expert panel, composed of Ontario-based long-term care home operators, clinicians and researchers, to produce Ontario benchmarks that represent good resident outcomes and high-quality care. The benchmark for this indicator was set at 1% by an expert panel through a modified Delphi process (2012 & 2015). Alongside public reporting performance indicators, benchmarks are an important tool for supporting long-term care homes and sector stakeholders in tracking progress, setting priorities or targets, and learning from homes that are excelling.

06/10/2025 10:45:00