Indicator Metadata

Experiencing Pain in Long-Term Care

Percentage of Residents With Pain

This indicator looks at how many long-term care residents had pain. The consequences of pain include increased difficulty with activities of daily living (ADLs), depression and lower quality of life. The prevalence of persistent pain increases with age, and proper treatment of pain is necessary to improve the health status of residents.

This indicator examines the percentage of residents who had pain. It is calculated by dividing the number of residents who had moderate daily pain or horrible/excruciating pain at any frequency by the number of all residents with valid assessments within the applicable time period.

Unit of Analysis: Resident

Place of service

Percentage or proportion

The following covariates are used in risk adjustment:
Individual Covariates:

• Cognitive Performance Scale (CPS)
• Long-term memory problem
• Age younger than 65

Facility-Level Stratification:

• Depression Rating Scale (DRS)

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

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

Exclusions:

1. Residents who have no pain symptoms frequency (J2a = 0) AND have pain symptoms intensity (J2b = 1, 2, 3) on their target assessment

Description:
Residents with moderate pain at least daily or horrible/excruciating pain at any frequency documented on their target assessment
Inclusions:
Variables include

• Pain symptoms frequency (J2a)
• Pain symptoms intensity (J2b)

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

Exclusions:

1. Residents who have no pain symptoms frequency (J2a = 0) AND have pain symptoms intensity (J2b = 1, 2, 3) on their target assessment

Canadian Institute for Health Information. When a Nursing Home Is Home: How Do Canadian Nursing Homes Measure Up on Quality? (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.

CCRS

Type of Year:
Fiscal
First Available Year:
2010
Last Available Year:
2019

Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon

Province/Territory, Region, Facility, Corporation, Sector (residential and hospital-based continuing care)

Every year

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Not applicable

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 from 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.

Some jurisdictions have implemented or are in the process of implementing the new interRAI Long-Term Care Facilities (LTCF), the next-generation clinical assessment instrument for long-term care. Data collected using this assessment instrument will be submitted to the Integrated interRAI Reporting System (IRRS). Results for these jurisdictions as of the fiscal year of interRAI LTCF implementation are not available at this time. Historical results based on the RAI-MDS 2.0 are available.
Coverage is incomplete for some fiscal years in the following jurisdictions:

• Saskatchewan (implemented and started collecting data using the interRAI LTCF in 2019–2020)
• Manitoba (includes all facilities in Winnipeg Regional Health Authority only)
• New Brunswick (implemented and started collecting data using the interRAI LTCF in 2017–2018)
• Nova Scotia

Indicators are risk-adjusted to control for potential confounding factors.

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).

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.