Indicator Metadata

Summary View
Detailed View

Name	Falls in the Last 30 Days in Long-Term Care
Short/Other Names	Percentage of Residents Who Fell in the Last 30 Days
Description	This indicator looks at how many long-term care residents fell in the 30 days leading up to the date of their quarterly clinical assessment. Falls are the leading cause of injury for seniors and contribute to a significant burden on the health care system. Residents are at a higher risk of falling if they have a history of falls or are taking certain medications. Preventing falls increases the safety and quality of care of residents.
Interpretation	Lower is better. It means that a lower percentage of long-term care residents had a fall in the month leading up to their quarterly assessment.
HSP Framework Dimension	Health System Outputs: Safe
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

Name	Falls in the Last 30 Days in Long-Term Care
Short/Other Names	Percentage of Residents Who Fell in the Last 30 Days

Indicator Description and Calculation

Description	This indicator looks at how many long-term care residents fell in the 30 days leading up to the date of their quarterly clinical assessment. Falls are the leading cause of injury for seniors and contribute to a significant burden on the health care system. Residents are at a higher risk of falling if they have a history of falls or are taking certain medications. Preventing falls increases the safety and quality of care of residents.
Calculation: Description	This indicator examines the percentage of residents who fell in the 30 days leading up to the date of their quarterly clinical assessment. It is calculated by dividing the number of residents who had a fall in those 30 days 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: Not totally dependent in transferring; locomotion problem; Personal Severity Index subset 2 (non-diagnoses); any wandering; unsteady gait/cognitive impairment; 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
Numerator	Description: Residents who had a fall in the last 30 days recorded on their target assessment (J4a = 1) 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: None

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 long-term care residents had a fall in the month leading up to their quarterly assessment.
HSP Framework Dimension	Health System Outputs: Safe
Areas of Need	Living With Illness, Disability or Reduced Function
Targets/Benchmarks	CIHI: None Health Quality Ontario (external): 9% 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: 2018
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:

– Saskatchewan
– 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/en/quick-stats.