Worsened-Symptoms-of-Depression - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Percentage of long-term care home residents whose mood from symptoms of depression worsened

Alternate Name

Percentage of long-term care home residents who suffered increased symptoms of depression

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of long-term care home residents whose mood from symptoms of depression worsened 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

Dimension

Effective, Patient-centred

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 with increased symptoms of depression (higher Depression Rating Scale (DRS) score on their target resident assessment 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 whose symptoms of depression could worsen (i.e., excludes residents who had a maximum DRS score on their previous assessment)

Adjustment (risk, age/sex standardization)- generalized

Risk adjusted

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

Includes only residents in long-stay beds. Rolling 4 quarter averages stabilize the rates from quarter-to-quarter variations, especially for smaller facilities, but make it more difficult to detect quarterly changes. Risk-adjusted values are censored if the denominator is less than 30. General limitations when using RAI-MDS data, including random error, coding errors, and missing values. The indicator calculation is based on the Depression Rating Scale (DRS), and measures an increase in the number and frequency of symptoms of depression. The indicator does not measure a clinical diagnosis of depression. The DRS has low correlation with the Geriatric Depression Scale (GDS) as well as with other instruments. [1,2] DRS is limited by a larger floor effect than the Geriatric Depression Scale (GDS). [3] In a 2013 study, the DRS was shown to be poor at distinguishing between older adults with and without a medical diagnosis of depression or between older adults who were or were not prescribed antidepressant medications. [4] 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.