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INDICATOR NAME
Name
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
Alternate Name
Percentage of long-term care home residents with new or worsening pressure ulcers
 
INDICATOR DESCRIPTION
Description
This indicator measures the 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 since their previous resident assessment. The indicator is calculated as a rolling 4 quarter average. This indicator was jointly developed by interRAI and the Canadian Institute for Health Information (CIHI). A lower percentage is better.
Indicator Status
Active
HQO Reporting tool/product
Public reporting, Quality Improvement Plans (QIPs)
Dimension
Safe
Type
Outcome
 
DEFINITION AND SOURCE INFORMATION
Unit of Measurement
Percentage
Calculation Methods
The indicator is calculated using 4 rolling quarters of data by summing the number of residents that meet the inclusion criteria for the target quarter and each of the previous 3 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.
Numerator including inclusion/exclusion

Number of LTC home residents in a fiscal quarter who had a pressure ulcer at stage 2 to 4 on their target Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessment and either they did not have a pressure ulcer on their previous assessment or the stage of pressure ulcer is greater on their target compared with their previous 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]

Denominator including inclusion/exclusion

Number of LTC residents in a fiscal quarter with 2 valid RAI-MDS assessments, excluding those who had a stage 4 pressure ulcer on their prior assessment (i.e., residents are only included if they did not have a pressure ulcer at the maximum stage on their previous assessment)

Inclusions:

LTC home residents with 2 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 an 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:

  1. Prev_M2a = 4

Where, 

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

Adjustment (risk, age/sex standardization)- detailed

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

Individual covariates:

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

Direct standardization:

  • Case Mix Index (CMI)*

*The relative resource use compared to the overall average resource use for all Ontario LTC home residents

Data Source
Continuing Care Reporting System (CCRS)
Data provided to HQO by
Canadian Institute for Health Information (CIHI)
Reported Levels of comparability /stratifications (defined)
Institution, Province, Region, Rurality, Time
 
RESULT UPDATES
Indicator Results
 
OTHER RELEVANT INFORMATION
Caveats and Limitations
Some anecdotal evidence that assessors may not remove bandages to assess ulcers or re-stage pressure ulcers as instructed in RAI-MDS manual. The indicator calculation is based on the stage of pressure ulcer for the pressure ulcer at the highest stage, so 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. Includes only long-stay beds. The indicator uses 4 rolling quarters of data to have a sufficient number of assessments for risk-adjustment and to stabilize the indicator results from quarter-to-quarter variations, especially for smaller facilities, but this methodology makes it more difficult to detect quarterly changes. Risk-adjusted values are censored if the denominator is less than 30. There are also general limitations when using RAI-MDS data, including random error, coding errors, and missing values.
Comments Detailed
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 7 days from 0 (no ulcer) to 4 (ulcer reaches muscle and bone). The unadjusted indicator result is an additional indicator in Quality Improvement Plans (QIPs). The reporting period for current performance in QIPs is Q2 (July - September), which represents the data in Q2 as well as the previous 3 quarters. This was a Quality Improvement Plan (QIP) additional indicator for 2018/19, however retired from 2019/20. Data are based on information from mandatory Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessments. The RAI-MDS is a standardized assessment that is completed for each resident upon admission to LTC and quarterly thereafter by the resident’s care team by reviewing the resident's medical records and speaking to the resident and their family. Health Quality Ontario 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.
 
TAGS
Sector
Long Term Care
Type
Outcome
Topic
Aging, Patient Safety and Never Events
Dimension
Safe
Source
Continuing Care Reporting System (CCRS)
 
PUBLISH
Publish Datetime
21/01/2019 17:40:00