NamePercentage of Residents in Daily Physical Restraints
Short/Other Names

Restraint Use in Long-Term Care

DescriptionPercentage of residents in daily physical restraints
InterpretationA high number indicates a higher percentage of residents in restraints; thus a lower percentage is desirable.
HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Living With Illness, Disability or Reduced Function

Geographic Coverage

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

Reporting Level/Disaggregation

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

Latest Result Update Date

09/2014

Indicator Results

Data results will be available in September 2014

Identifying Information
NamePercentage of Residents in Daily Physical Restraints
Short/Other Names

Restraint Use in Long-Term Care

Indicator Description and Calculation
DescriptionPercentage of residents in daily physical restraints
Calculation: Description

Residents who were physically restrained daily on their target assessment out of all residents with valid assessments within the applicable period of time specified

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: None

Facility-Level Stratification: Activities of Daily Living (ADLs) 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
Exclusions:
1. Residents who are comatose (B1 = 1) or quadriplegic (I1bb = 1)

Numerator

Description:
Residents who were physically restrained daily on their target assessment. For this indicator, restraints included

– Trunk Restraint (P4c = 2)
– Limb Restraint (P4d = 2)
– Chair Prevents Rising (P4e = 2)
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 are comatose (B1 = 1) or quadriplegic (I1bb = 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

A high number indicates a higher percentage of residents in restraints; thus a lower percentage is desirable.

HSP Framework Dimension

Health System Outputs: Person-centred

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

CIHI: None

Health Quality Ontario (external): 3% for long-term care

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.

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:
2003
Last Available Year:
2012

Geographic Coverage

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

Reporting Level/Disaggregation

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

Result Updates
Update Frequency

Every year

Latest Result Update Date

09/2014

Indicator Results

Web Tool:
Interactive Facility/Regional Website
URL:
Data results will be available in September 2014

Updates

Not applicable

Quality Statement
Caveats and Limitations

As the 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.

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 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 the CCRS eReports is updated on a quarterly basis.