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Indicator Metadata

NameExperiencing Pain in Long-Term Care
Short/Other Names

Percentage of Residents With Pain

DescriptionThis indicator looks at how many long-term care residents had pain. The consequences of pain include increased difficulty with activities of daily living (ADLs), depression and lower quality of life. The prevalence of persistent pain increases with age, and proper treatment of pain is necessary to improve the health status of residents.
InterpretationLower is better. It means that a lower percentage of residents had moderate daily pain or horrible/excruciating pain at any frequency.
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 Pain in Long-Term Care
Short/Other Names

Percentage of Residents With Pain

Indicator Description and Calculation
DescriptionThis indicator looks at how many long-term care residents had pain. The consequences of pain include increased difficulty with activities of daily living (ADLs), depression and lower quality of life. The prevalence of persistent pain increases with age, and proper treatment of pain is necessary to improve the health status of residents.
Calculation: Description

This indicator examines the percentage of residents who had pain. It is calculated by dividing the number of residents who had moderate daily pain or horrible/excruciating pain at any frequency by the number of all 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:

–Cognitive Performance Scale (CPS)

–Long-term memory problem

–Age younger than 65

Facility-Level Stratification:

–Depression Rating Scale (DRS)

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
Exclusions:
1. Residents who have no pain symptoms frequency (J2a = 0) AND have pain symptoms intensity (J2b = 1, 2, 3) on their target assessment

Numerator

Description:
Residents with moderate pain at least daily or horrible/excruciating pain at any frequency documented on their target assessment
Inclusions:
Variables include

–Pain symptoms frequency (J2a)

–Pain symptoms intensity (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
Exclusions:
1. Residents who have no pain symptoms frequency (J2a = 0) AND have pain symptoms intensity (J2b = 1, 2, 3) on their target 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 moderate daily pain or horrible/excruciating pain at any frequency.

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 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.

Health Quality Ontario. Health Quality Ontario Indicator Library. Accessed October 4, 2016.

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.

Availability of Data Sources and Results
Data Sources

CCRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2015

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 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).

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_2015-2016_en-web.xlsx.