Residents With a Stage 2 to 4 Pressure Ulcer

This indicator looks at how many long-term care residents had a stage 2 to 4 pressure ulcer.

Lower is better; it means that a lower percentage of long-term care residents had a stage 2 to 4 pressure ulcer.

Data availability: (fiscal years)
Geographic coverage
Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon
Reporting level
Province/Territory, Region, Facility, Corporation
Calculation

Percentage of residents who had a stage 2 to 4 pressure ulcer on their target assessment

Unit of Analysis: Resident

Denominator

Residents with valid assessments

Numerator

Residents who had a stage 2 to 4 pressure ulcer on their target assessment

The CCRS eReports provide authorized users with secure and timely access to key clinical administrative information from the Continuing Care Reporting System (CCRS). The reports are available to organizations submitting data to CCRS, their health authorities and ministries of health, and are updated on a quarterly basis.

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The Integrated interRAI Reporting System Long-Term Care (IRRS LTC) Secure Reporting tool aggregates pan-Canadian long-term care data from LTC homes. Authorized users can explore organization-level data, compare results with peers within and across jurisdictions and see trends over time.

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Name

Residents With a Stage 2 to 4 Pressure Ulcer

Short/Other Names

Percentage of Residents Who Had a Stage 2 to 4 Pressure Ulcer (PRU05)

Description

This indicator looks at how many long-term care residents had a stage 2 to 4 pressure ulcer. Pressure ulcers can happen when a resident sits or lies in the same position for a long period of time. Immobility may be due to many physical and psychological factors, neurological diseases like Alzheimer’s and improper nutrition or hydration. Careful monitoring is required to ensure good quality of care.

Rationale

Long-term care quality indicators were developed by interRAI, 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 that are 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 long-term care residents had a stage 2 to 4 pressure ulcer.

HSP Framework Dimension

Safe

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

CIHI: None

Available Data Years

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

Web Tool:
CCRS eReports (RAI-MDS 2.0) via My Services (log in)

Web Tool:
IRRS LTC Secure Reporting tool via My Services (log in)

Update Frequency

Monthly (IRRS LTC Secure Reporting tool)

Quarterly (CCRS eReports)

Updates

Not applicable

Description

Percentage of residents who had a stage 2 to 4 pressure ulcer on their target assessment

Unit of Analysis: Resident

Type of Measurement

Percentage or proportion

Denominator

Description:

Residents with valid assessments

Inclusions:

Residents with valid assessments. To be considered valid, the target assessment must

  • Be the latest assessment in the quarter
  • Be carried out more than 92 days after the Admission Date
  • Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF)

Exclusions:

None

Numerator

Description:

Residents who had a stage 2 to 4 pressure ulcer on their target assessment

Inclusions:

Residents with valid assessments. To be considered valid, the target assessment must

  • Be the latest assessment in the quarter
  • Be carried out more than 92 days after the Admission Date
  • Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF)

Exclusions:

None

Method of Adjustment

Direct standardization

Stratification, indirect standardization

Standard population
3,000 facilities in 6 U.S. states and 92 residential care facilities and continuing care hospitals in Nova Scotia and Ontario

Adjustment Applied

Covariates used in risk adjustment:

Individual covariates:

  • Personal Severity Index (PSI): Subset 1 — Diagnoses
  • More dependence in toileting
  • Resource Utilization Group (RUG): Cognitive Impairment
  • Age younger than 65

Facility-level stratification: Case Mix Index (CMI)

Geographic Assignment

Place of service

Data Sources

Caveats and Limitations

This measure uses data collected by long-term care facilities using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS 2.0) and submitted to the Continuing Care Reporting System (CCRS), or using the interRAI Long-Term Care Facilities (interRAI LTCF) assessment and submitted to the Integrated interRAI Reporting System (IRRS). 

Certain provinces and territories have transitioned to or are in the process of transitioning to the newer interRAI LTCF assessment instrument (see Trending Issues for more information). For a number of years, the national average (where available) will be based on both assessment instruments. To support inclusion of interRAI LTCF assessment data in public reporting, CIHI has completed an analysis to understand similarities and differences between the 2 assessment instruments. Overall, indicator results are comparable and appropriate to be trended over time and across instruments.

Trending Issues

The number of long-term care homes and jurisdictions submitting data to CIHI varies over time and has been generally increasing. Furthermore, as long-term care homes transition from the RAI-MDS 2.0 to the interRAI LTCF, there may be changes in data coverage that can impact the results (see more details below). Time series changes must be interpreted carefully, particularly when comparing the national average over time and when comparing provincial/territorial averages over the transition to the new assessment instrument. Please note that indicator results are risk-adjusted to control for population differences (factors that are beyond the facility’s control but that can affect resident outcomes) to enable more appropriate and fair comparisons of the actual quality of care. Please refer to CCRS Quality Indicators Risk Adjustment Methodology in the References section for more information.

Use of interRAI LTCF: As jurisdictions transition to/adopt the interRAI LTCF, there may be disruptions or delays in data submission to CIHI, which can impact the coverage of data and therefore indicator results. A summary of interRAI LTCF transition/adoption by jurisdiction is provided below for reference:

  • Nova Scotia started the transition in 2022; the transition is ongoing. 
  • New Brunswick completed adoption between 2016 and 2017 and started submitting data to IRRS in 2019. 
  • Saskatchewan completed the transition in 2019 and 2020 and started submitting data to IRRS in 2020.
  • Alberta started the transition in 2021; the transition is ongoing. Currently, only data from the RAI-MDS 2.0 is submitted to CIHI (CCRS) and included in reporting.

CIHI recognizes that the COVID-19 pandemic has affected many long-term care homes across Canada, including their ability to complete assessments and/or submit data to CIHI. Available data may vary by jurisdiction and facility. Results should be interpreted in the context of the COVID-19 pandemic.

Comments

The long-term care 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. 

References

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

Health Quality Ontario. Health Quality Ontario Indicator Library. Accessed October 4, 2017.

Health Quality Ontario. Long-Term Care Benchmarking Resource Guide (PDF). 2013.

Health Quality Ontario. Results From Health Quality Ontario's Benchmark Setting for Long-Term Care Indicators (PDF). 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.

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