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Percentage of Residents Whose Mood Symptoms of Depression Worsened
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Short/Other Names
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MOD4A

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Description
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Percentage of residents whose mood symptoms of depression worsened
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Interpretation
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A high number indicates a higher percentage of residents with an increase in depressive mood; thus a lower percentage is desirable.
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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Living With Illness, Disability or Reduced Function

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Geographic Coverage
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Newfoundland and Labrador, Nova Scotia, Ontario, Manitoba, British Columbia, Yukon

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Reporting Level/Disaggregation
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Province/Territory, Sector (residential and hospital-based continuing care)

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Latest Result Update Date
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07/2013

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Indicator Results
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http://www.cihi.ca/CIHI-ext-portal/xls/internet/STAT_PROFILE_RES_12-13_EN

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Identifying Information
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Name
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Percentage of Residents Whose Mood Symptoms of Depression Worsened
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Short/Other Names
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MOD4A

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Indicator Description and Calculation
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Description
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Percentage of residents whose mood symptoms of depression worsened
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Calculation: Description
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Residents with a higher Depression Rating Scale (DRS) score on their target assessment than on their prior assessment

Unit of Analysis: Resident

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Calculation: Geographic Assignment
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Place of service

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Calculation: Type of Measurement
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Percentage or proportion

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Calculation: Adjustment Applied
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The following covariates are used in risk adjustment:
Individual covariates: Age younger than 65

Facility-level stratification: Case Mix Index (CMI)

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Calculation: Method of Adjustment
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Stratification, direct standardization, indirect standardization
Standard Population:
3,000 facilities in 6 U.S. states and 92 residential care facilities and continuing care hospitals in Ontario and Nova Scotia

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Description:
Residents with valid assessments

As this is an incidence indicator, the resident must also have had an assessment in the previous quarter, with 45 to 165 days between the target and prior assessments. If multiple assessments in the previous quarter meet the time period criteria, the latest assessment is selected as the prior assessment.

The DRS ranges from 0 to 14, with higher values indicating the resident has more numerous and/or frequent symptoms from the following list of data elements used to calculate it:

– Resident Makes Negative Statements (E1a)

– Persistent Anger With Self/Others (E1d)

– Expression of Unrealistic Fears (E1f )

– Repetitive Health Complaints (E1h)

– Repetitive Anxious Complaints/Concerns (E1i)

– Sad/Pained/Worried Facial Expressions (E1l)

– Crying/Tearfulness (E1m)
Inclusions:
1. Residents with valid assessments. To be considered valid, the target assessment must

a. Be the latest assessment in the quarter

b. Be carried out more than 92 days after the Admission Date

c. Not be an Admission Full Assessment
Exclusions:
1. Residents whose depression symptoms could not worsen (had a maximum DRS score of 14 on prior assessment)

2. Residents who were comatose (B1 = 1)

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Description:
Residents with a higher DRS score on their target assessment than on their prior assessment

As this is an incidence indicator, the resident must also have had an assessment in the previous quarter, with 45 to 165 days between the target and prior assessments. If multiple assessments in the previous quarter meet the time period criteria, the latest assessment is selected as the prior assessment.
Inclusions:
1. Residents with valid assessments. To be considered valid, the target assessment must

a. Be the latest assessment in the quarter

b. Be carried out more than 92 days after the Admission Date

c. Not be an Admission Full Assessment

2. Residents with a higher DRS score on their target assessment than on their prior assessment
Exclusions:
1. Residents who had a maximum DRS score (14) on their prior assessment

2. Residents who were comatose (B1 = 1)

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Background, Interpretation and Benchmarks
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Rationale
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CCRS quality indicators were developed by interRAI (www.interrai.org), an international research network, to provide organizations with measures of quality across key domains, including physical and cognitive function, safety and quality of life. Each indicator is adjusted for resident characteristics that are related to the outcome and independent of quality of care. The indicators can be used by quality leaders to drive continuous improvement efforts. They are also used to communicate with key stakeholders through report cards and accountability agreements.

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Interpretation
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A high number indicates a higher percentage of residents with an increase in depressive mood; thus a lower percentage is desirable.

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HSP Framework Dimension
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Health System Outputs: Appropriate and effective

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Areas of Need
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Living With Illness, Disability or Reduced Function

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Targets/Benchmarks
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CIHI: None

Health Quality Ontario (external): 13% for long-term care

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References
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Canadian Institute for Health Information. CCRS Quality Indictors Risk Adjustment Methodology. Ottawa, ON: CIHI; 2013.

Canadian Institute for Health Information. When a Nursing Home Is Home: How Do Canadian Nursing Homes Measure Up on Quality? Ottawa, ON: CIHI; 2013.

Health Quality Ontario. Long Term Care Benchmarking Resource Guide. Toronto, ON: HQO; 2013.

Hirdes JP, Mitchell L, Maxwell CJ, White N. Beyond the 'iron lungs of gerontology': using evidence to shape the future of nursing homes in Canada. Can J Aging 2011;30(3):371-390. PM:21851753.

Hirdes JP, Poss JW, Caldarelli H, et al. An evaluation of data quality in Canada's Continuing Care Reporting System (CCRS): secondary analyses of Ontario data submitted between 1996 and 2011. BMC Med Inform Decis Mak 2013;13:27. PM:23442258.

Jones RN, Hirdes JP, Poss JW, et al. Adjustment of nursing home quality indicators. BMC Health Serv Res 2010;10:96. PM:20398304.

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Availability of Data Sources and Results
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Data Sources
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CCRS

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Available Data Years
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Type of Year:
Fiscal
First Available Year:
2003
Last Available Year:
2012

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Geographic Coverage
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Newfoundland and Labrador, Nova Scotia, Ontario, Manitoba, British Columbia, Yukon

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Reporting Level/Disaggregation
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Province/Territory, Sector (residential and hospital-based continuing care)

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Result Updates
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Update Frequency
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Every year

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Latest Result Update Date
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07/2013

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Indicator Results
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Web Tool:
Quick Stats
URL: http://www.cihi.ca/CIHI-ext-portal/xls/internet/STAT_PROFILE_RES_12-13_EN

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Updates
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Not applicable

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Quality Statement
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Caveats and Limitations
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The Continuing Care Reporting System (CCRS) frame does not currently contain all facilities in all provinces and territories that make up the CCRS population of interest. Users should be cautious when interpreting results from CCRS, as the population covered by CCRS may not be representative of all continuing care facilities across Canada.

Coverage is incomplete in the following jurisdictions:

– Manitoba (includes all facilities in Winnipeg Regional Health Authority only)

– Nova Scotia

– Newfoundland and Labrador

Indicators are risk-adjusted to control for potential confounding factors.

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Trending Issues
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Since 2003, the number of facilities and jurisdictions submitting to CCRS has been increasing. With the addition of new jurisdictions, it is possible that differences in care practices may affect indicator rates; however, changes to the underlying population would be controlled for using risk adjustment. There is also evidence to suggest that trending and use of data from the entire time series is not an issue and that data quality is consistent over time (Hirdes et al., 2013).

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Comments
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The CCRS quality indicators use four rolling quarters of data for calculations in order to have a sufficient number of assessments for risk adjustment. Since residents are assessed on a quarterly basis, each resident can contribute to the indicator up to four times.

Although the CCRS quality indicators are reported publicly at the provincial/territorial level only, indicator results are available at other levels (facility, corporation, region) to data submitters in the CCRS eReports application. Data in CCRS eReports is updated on a quarterly basis.