Export indicator metadata as an Excel file See Indicator Results: View indicator results as an interactive web page (opens in a new window) or download indicator results as a PDF

Indicator Metadata

Name

Percentage of Residents Who Had a Newly Occurring Stage 2 to 4 Pressure Ulcer

Short/Other Names

PRU09

Description

Percentage of residents who had a newly occurring stage 2 to 4 pressure ulcer

Interpretation

A high number indicates a higher percentage of residents who had a newly occurring stage 2 to 4 pressure ulcer on their target assessment; thus a lower percentage is desirable.

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

https://www.cihi.ca/en/quick-stats

Identifying Information
Name

Percentage of Residents Who Had a Newly Occurring Stage 2 to 4 Pressure Ulcer

Short/Other Names

PRU09

Indicator Description and Calculation
Description

Percentage of residents who had a newly occurring stage 2 to 4 pressure ulcer

Calculation: Description

Residents who had a pressure ulcer at stage 2 to 4 on their target assessment and no pressure ulcer at stage 2 to 4 on their prior assessment

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


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
    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


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 a pressure ulcer greater than or equal to stage 2 (M2a = 2 or higher) on their prior assessment
Numerator

Description:
Residents who had a pressure ulcer at stage 2 to 4 on their target assessment and no pressure ulcer at stage 2 to 4 on their prior assessment

Inclusions:

  1. Residents who had a pressure ulcer on their target assessment (M2a = 2 or higher)
  2. 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


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 a pressure ulcer greater than or equal to stage 2 (M2a = 2 or higher) on their 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 A high number indicates a higher percentage of residents who had a newly occurring stage 2 to 4 pressure ulcer on their target assessment; thus a lower percentage is desirable.
HSP Framework Dimension Health System Outputs: Safe
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 (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

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:
Quick Stats
URL: https://www.cihi.ca/en/quick-stats

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). 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 Long-Term Care Facilities (interRAI LTCF) assessment instrument.

Results for these jurisdictions as of the fiscal year of interRAI LTCF implementation are not available at this time (for this indicator). Historical results, where available, are based on the RAI-MDS 2.0.

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.

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 CCRS eReports is updated on a quarterly basis.