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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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Lower is better. It means that a lower percentage of residents had symptoms of depression that worsened.

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HSP Framework Dimension
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Health System Outcomes: Improve health status of Canadians

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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 Indicators 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.

Health Quality Ontario. Results From Health Quality Ontario's Benchmark Setting for Long-Term Care Indicators. 2017.

Health Quality Ontario. Health Quality Ontario Indicator Library. Accessed October 4, 2017.

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

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

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

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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:
2010
Last Available Year:
2014 2017

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Geographic Coverage
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Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon

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

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Update Frequency
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Every year

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Indicator Results
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Web Tool:
Your Health System: In Depth
RLURL:
Accessing Indicator Results on Your Health System: In Depth

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Updates
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Not applicable

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

Coverage is incomplete in the following jurisdictions:

Saskatchewan
Manitoba (includes all facilities in Winnipeg Regional Health Authority only)
– New Brunswick
– 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 4 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 4 times.

Data for this indicator is also available in the Quick Stats tool, which includes results for both the residential and hospital-based continuing care sectors: https://www.cihi.ca/sites/default/files/document/ccrs_quickstats_14_15_-quick-stats-2016-2017-en.xlsx.

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