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Name
Worsened Physical Functioning in Long-Term Care
Short/Other Names

Percentage of Residents Whose Mid-Loss ADL Functioning (Transfer and Locomotion) Worsened or Who Remained Completely Dependent in Mid-Loss ADLs

Description
This indicator looks at how many long-term care residents worsened or remained completely dependent in transferring and locomotion. An increased level of dependence on others to assist with transferring and locomotion may indicate deterioration in the overall health status of a resident.
Interpretation
Lower is better. It means that a lower percentage of residents worsened or remained dependent 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

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
Name
Worsened Physical Functioning in Long-Term Care
Short/Other Names

Percentage of Residents Whose Mid-Loss ADL Functioning (Transfer and Locomotion) Worsened or Who Remained Completely Dependent in Mid-Loss ADLs


<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>
Description
This indicator looks at how many long-term care residents worsened or remained completely dependent in transferring and locomotion. An increased level of dependence on others to assist with transferring and locomotion may indicate deterioration in the overall health status of a resident.
Calculation: Description

This indicator examines the percentage of residents who worsened or remained dependent in transferring and locomotion (mid-loss ADLs). It is calculated by dividing the number of residents whose mid-loss ADLs worsened or who remained dependent (had a maximum score) 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:

–Not totally dependent in transferring

–Locomotion problem

–Personal Severity Index (PSI): Subset 2—Non-Diagnoses

–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
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 worse mid-loss ADL self-performance (increased score) on their target assessment compared with their prior assessment or a maximum score on both prior and target assessments
Inclusions:
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)


<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>
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 worsened or remained dependent 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.


<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
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)


<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
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


<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
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)
– Nova Scotia
– New Brunswick

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-2016-2017-en.xlsx.

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