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Indicator Metadata

Name

Experiencing Worsened Pain in Long-Term Care

Short/Other Names

Percentage of Residents Whose Pain Worsened (PAN01)

Description

This indicator looks at how many long-term care residents had worsened pain. Worsening pain can be related to a number of issues, including medication complications and/or improper management of medication. Careful monitoring of changes in pain can help identify appropriate treatment. Worsened pain raises concerns about the resident's health status and the quality of care received.

Interpretation

Lower is better. It means that a lower percentage of residents had worsened pain.

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
Name

Experiencing Worsened Pain in Long-Term Care

Short/Other Names

Percentage of Residents Whose Pain Worsened (PAN01)

Indicator Description and Calculation
Description

This indicator looks at how many long-term care residents had worsened pain. Worsening pain can be related to a number of issues, including medication complications and/or improper management of medication. Careful monitoring of changes in pain can help identify appropriate treatment. Worsened pain raises concerns about the resident's health status and the quality of care received.

Calculation: Description

This indicator examines the percentage of residents who had worsened pain. It is calculated by dividing the number of residents who had worsened pain by the number of all residents with valid assessments whose symptoms could worsen 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:

  • 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 whose pain symptoms could increase

The Pain Scale ranges from 0 to 3 (RAI-MDS 2.0) or 0 to 4 (interRAI LTCF), with higher values indicating that the resident has a more severe pain experience.

Data elements used to calculate the Pain Scale:

  • Frequency of Pain (RAI-MDS 2.0: J2a; interRAI LTCF: J5a)
  • Intensity of Pain (RAI-MDS 2.0: J2b; interRAI LTCF: J5b)

Inclusions:

  1. Residents with valid assessments. To be considered valid, the target assessment must
    1. Be the latest assessment in the quarter
    2. Be carried out more than 92 days after the Admission Date
    3. Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF)


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 had the highest Pain Scale score (RAI-MDS 2.0: 3; interRAI LTCF: 3, 4) on the prior assessment
Numerator

Description:
Residents with greater pain (higher Pain Scale score) on their target assessment than on their prior assessment

Inclusions:

  1. Residents with valid assessments. To be considered valid, the target assessment must
    1. Be the latest assessment in the quarter
    2. Be carried out more than 92 days after the Admission Date
    3. Not be an Admission Full Assessment (RAI-MDS 2.0) or First Assessment (interRAI LTCF)


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 had the highest Pain Scale score (RAI-MDS 2.0: 3; interRAI LTCF: 3, 4) on the prior assessment
Background, Interpretation and Benchmarks
Rationale

Long-term care 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 worsened pain.

HSP Framework Dimension

Health System Outcomes: Improve health status of Canadians

Areas of Need

Living With Illness, Disability or Reduced Function

Targets/Benchmarks

CIHI: None

Health Quality Ontario (external): 6% for long-term care

References

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

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.

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, IRRS

Available Data Years

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2020

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

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). Users should be cautious when interpreting results because the population covered does not include all continuing care facilities across Canada and therefore may not be representative of the population of interest.

New Brunswick and Saskatchewan have implemented the interRAI LTCF.

Results for jurisdictions that
• Are submitting data collected using the interRAI LTCF assessment instrument to IRRS; and
• Have submitted at least one full fiscal year of this data (including the latest complete fiscal year) from at least 65% of participating facilities

will be reported based on the interRAI LTCF. Results for these jurisdictions prior to implementation of the interRAI LTCF will continue to be based on the RAI-MDS 2.0, where available. Results for other jurisdictions will be based on the RAI-MDS 2.0 as well.

Coverage is incomplete (less than 95% of participating facilities submitting data) for the latest fiscal year for the following jurisdictions:
• Manitoba (includes all facilities in the Winnipeg Regional Health Authority only)
• Nova Scotia

Indicators are risk-adjusted to control for potential confounding factors. Please refer to the CCRS Quality Indicators Risk Adjustment Methodology in the References section.

Trending Issues

Since 2003, the number of long-term care homes submitting data to CIHI has been generally increasing. Furthermore, there may be variations over time in policies and procedures, and in service provision for long-term care across jurisdictions based on the local needs of their populations. Therefore, any time series changes must be interpreted carefully, as they may reflect what is occurring in the population but may be influenced by changes in the characteristics of the residents being served as well as by policies and procedures, quality initiatives and practices around the service provision occurring at that time. Please note that indicator results are risk-adjusted to control for population differences (factors that are beyond the facility’s control but can affect resident outcomes) to enable more appropriate and fair comparisons of the actual quality of care. Please refer to the CCRS Quality Indicators Risk Adjustment Methodology in the References section for more information.

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. 2020–2021 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.

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.