Pain-Among-Residents - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Percentage of long-term care home residents who experienced moderate pain daily or any severe pain during the 7 days prior to their most recent resident assessment

Alternate Name

Percentage of long-term care home residents who experienced moderate pain daily or any severe pain

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of long-term care home residents who experienced moderate pain daily or any severe pain during the seven days preceding their resident assessment. The consequences of pain include difficulty with activities of daily living (ADLs), depression and lower quality of life. The prevalence of persistent pain increases with age, and proper treatment of pain is necessary to improve the health status of residents. The indicator is calculated as a rolling four 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

Dimension

Effective, Patient-centred

Type

Outcome

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

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.

Numerator including inclusion/exclusion

Number of long-term care home residents in the denominator with moderate pain at least daily or horrible/excruciating pain at any frequency documented on their Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS) target assessment

Inclusions:

(J2a = 2 AND J2b = 2) OR J2b = 3

Where,

J2a = pain symptoms frequency [0,1,2]

0 = no pain

1 = pain less than daily

2 = pain daily

J2b = pain symptoms intensity [1,2,3]

1 = mild pain

2 = moderate pain

3 = times when pain is horrible or excruciating

Exclusions:

Resident assessments with no pain frequency (J2a = 0) AND have pain intensity (J2B = 1, 2, 3) on their target assessment

Denominator including inclusion/exclusion

Number of long-term care home residents in a fiscal quarter with a valid RAI-MDS 2.0 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 a RAI-MDS 2.0 Admission Full Assessment

Adjustment (risk, age/sex standardization)- detailed

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

Individual covariates:

Cognitive Performance Scale (CPS)
Long-term memory problem
Age younger than 65 years

Direct standardization:

Depression Rating Scale (DRS)

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, Time

RESULT UPDATES

Indicator Results

Click here to view Health Quality Ontario results for this indicator

OTHER RELEVANT INFORMATION

Caveats and Limitations

Pain is subjective in nature and can be difficult to measure. The results for this indicator include only residents in long-stay beds. 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.

Comments Detailed

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.