Percentage of long-term care home residents who fell in the last 30 days

Percentage of long-term care home residents who fell

Percentage

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.

Number of LTC home residents in a fiscal quarter who had a fall in the last 30 days recorded on their target Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) assessment 
Inclusions: 
J4a = 1 
Where, 
J4a = Fell in past 30 days [0,1]
0 = No 
1 = Yes

Number of LTC home residents in a fiscal quarter with a valid RAI-MDS assessment
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 an admission full assessment

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

Individual covariates:

• Not totally dependent in transferring 
• Locomotion problem 
• Personal Severity Index (PSI)*: Subset 2: Non-Diagnoses 
• Any wandering 
• Unsteady gait/cognitive impairment 
• Age younger than 65 

Direct standardization: 

• Case Mix Index (CMI)** 

*PSI is statistically linked to the likelihood of death within six months 
**The relative resource use compared to the overall average resource use for all Ontario LTC home residents

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Rurality, Time

Includes only residents in 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. Results for fiscal year 2020/21 should be interpreted with caution as the COVID-19 pandemic may have affected data collection. In Ontario, some LTC facilities were unable to complete and/or submit assessments. As a result, CIHI received fewer assessments during the pandemic than in previous years. Additionally, some facilities experienced a decline in admissions. The impact of COVID-19 on the data received by CIHI varies by jurisdiction. Readers are encouraged to interpret results, including comparisons and trends over time, with caution.

This indicator captures whether the resident fell in the last 30 days but does not capture whether the fall resulted in injury. Residents have a right to balance the risk of falls with their right to remain mobile and unrestrained; therefore, a certain number of falls are inevitable. The focus should be on reducing the number of falls, recognizing that some falls will occur, and preventing injuries associated with falls. The unadjusted indicator result is an additional indicator in Quality Improvement Plans (QIPs) and included in LTC Practice Reports. 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 9% 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.

25/02/2022 08:59:00