Indicator Metadata

NameImproved Physical Functioning in Long-Term Care
Short/Other Names

Percentage of Residents Whose Status Improved on Mid-Loss ADL Functioning (Transfer and Locomotion) or Remained Completely Independent in Mid-Loss ADLs

DescriptionThis indicator looks at how many long-term care residents improved or remained independent in transferring and locomotion. Being independent or showing an improvement in these 2 activities of daily living (ADLs) may indicate an improvement in overall health status and provide a sense of autonomy for the resident.
InterpretationHigher is better. It means that a higher percentage of residents improved or remained independent in transferring and locomotion (mid-loss ADLs).
HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Living With Illness, Disability or Reduced Function

Geographic Coverage

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

Reporting Level/Disaggregation

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

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameImproved Physical Functioning in Long-Term Care
Short/Other Names

Percentage of Residents Whose Status Improved on Mid-Loss ADL Functioning (Transfer and Locomotion) or Remained Completely Independent in Mid-Loss ADLs

Indicator Description and Calculation
DescriptionThis indicator looks at how many long-term care residents improved or remained independent in transferring and locomotion. Being independent or showing an improvement in these 2 activities of daily living (ADLs) may indicate an improvement in overall health status and provide a sense of autonomy for the resident.
Calculation: Description

This indicator examines the percentage of residents who improved or remained independent in transferring and locomotion (mid-loss ADLs). It is calculated by dividing the number of residents whose mid-loss ADLs improved or who remained independent by the number of all residents (excluding comatose and end-of-life residents) with valid assessments within the applicable time period.

Unit of Analysis: Resident

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Percentage or proportion

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
Individual covariates: Age younger than 65; Cognitive Performance Scale (CPS)

Facility-level stratification: Activities of Daily Living (ADL) Long Form Scale

Calculation: Method of Adjustment

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

Denominator

Description:
Residents with valid assessments
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

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.
Exclusions:
1. Residents who are comatose (B1 = 1), end-stage (J5c = 1) or receiving hospice care (P1ao = 1)

Numerator

Description:
Residents with improved mid-loss ADL self-performance (decreased score) on their target assessment, in comparison with their performance on their prior assessment, or a score of 0 on both prior and target assessments

Variables include

– Transfer Self-Performance (G1bA)

– Walk in Corridor Self-Performance (G1dA)

– Locomotion on Unit Self-Performance (G1eA)
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

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.
Exclusions:
1. Residents who are comatose (B1 = 1), end-stage (J5c = 1) or receiving hospice care (P1ao = 1)

Background, Interpretation and Benchmarks
Rationale

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.

Interpretation

Higher is better. It means that a higher percentage of residents improved or remained independent in transferring and locomotion (mid-loss ADLs).

HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

None

References

Canadian Institute for Health Information. CCRS Quality Indicators Risk Adjustment Methodology. 2013.

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

Health Quality Ontario. Long-Term Care Benchmarking Resource Guide. 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 evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging. 2011.

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 Medical Informatics and Decision Making. 2013.

Jones RN, Hirdes JP, Poss JW, et al. Adjustment of nursing home quality indicators. BMC Health Services Research. 2010.

Availability of Data Sources and Results
Data Sources

CCRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2016

Geographic Coverage

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

Reporting Level/Disaggregation

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

Result Updates
Update Frequency

Every year

Indicator Results

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

Updates

Not applicable

Quality Statement
Caveats and Limitations

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:

– Manitoba (includes all facilities in Winnipeg Regional Health Authority only)
– New Brunswick
– Nova Scotia

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

Trending Issues

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 impact 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).

Comments

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-quick-stats-2016-2017-en.xlsx.