Percentage of long-term care home residents without psychosis on antipsychotics in the last 7 days

Percentage of long-term care home residents without psychosis using antipsychotic medications

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 received antipsychotic medication on one or more days in the seven days before their Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 target assessment

Inclusions:

O4a = 1, 2, 3, 4, 5, 6 or 7

Where, O4A = Number of days the resident received an antipsychotic medication during the last 7 days [0-7]

Number of long-term care home residents in a fiscal quarter with a valid RAI-MDS 2.0 assessment, excluding those with schizophrenia, Huntington's chorea, hallucinations or delusions, as well as residents who are end-stage disease or receiving hospice/palliative care

Inclusions:

To be considered valid, the resident assessment 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

Exclusions:

1. Residents who are end-stage disease (J5c = 1) or receiving hospice/palliative care (P1ao = 1)
2. Residents who have a diagnosis of schizophrenia (I1ii = 1) or Huntington's chorea (I1x = 1), or those experiencing hallucinations (J1i = 1) or delusions (J1e = 1)

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

Individual covariates:

• Motor agitation
• Moderate/impaired decision-making problem
• Long-term memory problem
• Cognitive Performance Scale (CPS)
• Combination Alzheimer’s disease/other dementia
• 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 residents.

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Time

This indicator captures antipsychotic medication use over 7-day periods during the course of the year, so it will not capture all antipsychotic use. The presence of psychosis and antipsychotic use are determined from the same assessment, so residents may be on an antipsychotic for hallucinations or delusions that would no longer be present and therefore not captured in the RAI-MDS 2.0 target assessment. These residents would be counted in the numerator. Antipsychotic use does not consider dose or duration of use. 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.

Antipsychotic use is defined as any use by a resident in the seven days prior to the assessment date. Delusions and hallucinations are captured in the assessment if these conditions were present in the seven days prior to the assessment date. 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 19% by an expert panel through a modified Delphi process (2016). 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 11:04:00