Pressure-Ulcers-Among-Residents - Health Quality Ontario (HQO)

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.

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 (short description i.e. not inclusions/exclusions)

Number of LTC home residents in a fiscal quarter who had a pressure ulcer at stage 2 to 4 on their target resident 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

Denominator (short description i.e. not inclusions/exclusions)

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

Adjustment (risk, age/sex standardization)- generalized

Risk adjusted, Unadjusted in QIP

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

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 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.

Comments Summary

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.