Indicator Metadata

NameExperiencing Worsened Pain in Long-Term Care
Short/Other Names

Percentage of Residents Whose Pain Worsened

DescriptionThis indicator looks at how many long-term care residents had worsened pain. Worsening pain can be related to a number of issues, including medication complications and/or improper management of medication. Careful monitoring of changes in pain can help identify appropriate treatment. Worsened pain raises concerns about the resident's health status and the quality of care received.
InterpretationLower is better. It means that a lower percentage of residents had worsened pain.
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
NameExperiencing Worsened Pain in Long-Term Care
Short/Other Names

Percentage of Residents Whose Pain Worsened

Indicator Description and Calculation
DescriptionThis indicator looks at how many long-term care residents had worsened pain. Worsening pain can be related to a number of issues, including medication complications and/or improper management of medication. Careful monitoring of changes in pain can help identify appropriate treatment. Worsened pain raises concerns about the resident's health status and the quality of care received.
Calculation: Description

This indicator examines the percentage of residents who had worsened pain. It is calculated by dividing the number of residents who had worsened pain by the number of all residents with valid assessments whose symptoms increased 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

Facility-level stratification:
– Case Mix Index (CMI)

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 whose pain symptoms could increase

The Pain Scale ranges from 0 to 3, with higher values indicating that the resident has a more severe pain experience.

Data elements used to calculate the Pain Scale:

– Frequency of Pain (J2a)

– Intensity of Pain (J2b)
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 had the highest Pain Scale score (3) on the prior assessment

Numerator

Description:
Residents with greater pain (higher Pain Scale score) on their target assessment than on their 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

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 had the highest Pain Scale score (3) on the prior assessment

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

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

HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

CIHI: None

Health Quality Ontario (external): 6% for long-term care

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.