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<tr><td>Name</td><td>

Experiencing Worsened Pain in Long-Term Care

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<tr><td>Short/Other Names</td><td>

Percentage of Residents Whose Pain Worsened

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<tr><td>Description</td><td>

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.

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<tr><td>Interpretation</td><td>

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

</td></tr>

<tr><td>HSP Framework Dimension</td><td>

Health System Outcomes: Improve health status of Canadians

</td></tr>

<tr><td>Areas of Need</td><td>

Living With Illness, Disability or Reduced Function

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<tr><td>Geographic Coverage</td><td>

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

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<tr><td>Reporting Level/Disaggregation</td><td>

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

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<tr><td>Indicator Results</td><td>

Accessing Indicator Results on Your Health System: In Depth

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>

<table id="identifyingInfoRegion">

<tr><td>Name</td><td>

Experiencing Worsened Pain in Long-Term Care

</td></tr>

<tr><td>Short/Other Names</td><td>

Percentage of Residents Whose Pain Worsened

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<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>

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<tr><td>Description</td><td>

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.

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<tr><td>Calculation: Description</td><td>

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 increased within the applicable time period.

Unit of Analysis: Resident

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<tr><td>Calculation: Geographic Assignment</td><td>

Place of service

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<tr><td>Calculation: Type of Measurement</td><td>

Percentage or proportion

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<tr><td>Calculation:  Adjustment Applied</td><td>

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


Facility-level stratification:

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

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<tr><td>Denominator</td><td>

Description:
Residents with valid assessments whose pain symptoms could increase

The Pain Scale ranges from 0 to 3, with higher values indicating that the resident has a more severe pain experience.

Data elements used to calculate the Pain Scale:

  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 the highest Pain Scale score (3) on the prior assessment
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<tr><td>Numerator</td><td>

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


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 (3) on the prior assessment
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<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>

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<tr><td>Rationale</td><td>

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.

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<tr><td>Interpretation</td><td>

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

</td></tr>

<tr><td>HSP Framework Dimension</td><td>

Health System Outcomes: Improve health status of Canadians

</td></tr>

<tr><td>Areas of Need</td><td>

Living With Illness, Disability or Reduced Function

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<tr><td>Targets/Benchmarks</td><td>

CIHI: None

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

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<tr><td>References</td><td>

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

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.

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<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>

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<tr><td>Data Sources</td><td>

CCRS

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<tr><td>Available Data Years</td><td>

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

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<tr><td>Geographic Coverage</td><td>

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

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<tr><td>Reporting Level/Disaggregation</td><td>

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

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<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>

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<tr><td>Update Frequency</td><td>

Every year

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<tr><td>Indicator Results</td><td>

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

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<tr><td>Updates</td><td>

Not applicable

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<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>

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<tr><td>Caveats and Limitations</td><td>

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:


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

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<tr><td>Trending Issues</td><td>

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 impact 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).

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<tr><td>Comments</td><td>

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.

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