Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2019

Open Access 01-12-2019 | Care | Research article

Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for Ontario

Authors: Lisa E. Harman, Dawn M. Guthrie, Joachim Cohen, Anja Declercq, Kathryn Fisher, Donna Goodridge, John P. Hirdes, Hsien Seow

Published in: BMC Palliative Care | Issue 1/2019

Login to get access

Abstract

Background

Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment.

Methods

Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of less than 6 months to live or the presence of severe health instability. The rates of the QIs were stratified across Ontario’s geographic regions, and across four common life-limiting illnesses to observe variation.

Results

Within the sample, 14,312 clients were considered to be seriously ill and were more likely to experience negative health outcomes such as cognitive performance (OR = 2.77; 95% CI: 2.66–2.89) and pain (OR = 1.59; 95% CI: 1.53–1.64). Twenty subject matter experts were consulted and a list of seven QIs was developed. Indicators with the highest overall rates were prevalence of falls (50%) prevalence of daily pain (47%), and prevalence of caregiver distress (42%). The range in QI rates was largest across regions for prevalence of caregiver distress (21.5%), the prevalence of falls (16.6%), and the prevalence of social isolation (13.7%). Those with some form of dementia were most likely to have a caregiver that was distressed (52.6%) or to experience a fall (53.3%).

Conclusion

Home care clients in Ontario who are seriously ill are experiencing high rates of negative health outcomes, many of which are amenable to change. The RAI-HC can be a useful tool in identifying these clients in order to better understand their needs and abilities. These results contribute significantly to the process of creating and validating a standardized set of QIs that can be generated by organizations using the RAI-HC as part of normal clinical practice.
Literature
1.
Murray SA, Firth A, Schneider N, Van den Eynden B, Gomez-Batiste X, Brogaard T, et al. Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med. 2015;29(2):101–11.CrossRef
2.
Ferrell BR. Overview of the domains of variables relevant to end-of-life care. J Palliat Med. 2005;8(1):22–9.CrossRef
3.
Kitchen P, Williams A, Pong RW, Wilson D. Socio-spatial patterns of home care use in Ontario, Canada: a case study. Health Place. 2011;17(1):195–206.CrossRef
4.
Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower cost: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993–1000.CrossRef
5.
Lynn J. Living long in fragile health: the new demographics shape end of life care. Hast Cent Rep. 2005;35(7):S14–S8.CrossRef
6.
Walker H, Anderson M, Farahati F, Howell D, Librach SL, Husain A, et al. Resource use and cost of end-of-life/palliative care: Ontario adult cancer patients dying during 2002 and 2003. J Palliat Care. 2011;27(2):79–88.CrossRef
7.
Sussman J, Barbera L, Bainbridge D, Howell D, Yang J, Husain A, et al. Health system characteristics of quality care delivery: a comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada. Palliat Med. 2011;0(00):1–14.
8.
De Roo ML, Leemans K, Claessen SJJ, Cohen J, Pasman RW, Deliens L, et al. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manag. 2013;46(4):1–17.CrossRef
9.
Leemans K, Deliens L, Van den Block L, Vander Stichele R, Francke AL, Cohen J. Systematic quality monitoring for specialized palliative care services: development of a minimal set of quality indicators for palliative care study (QPAC). Am J Hosp Palliat Med. 2016;34:532-46.
10.
De Schreye R, Houttekier D, Deliens L, Cohen J. Developing indicators of appropriate and inappropriate end-of-life care in people with Alzheimer's disease, cancer or chronic obstructive pulmonary disease for population-level administrative databases: a RAND/UCLA appropriateness study. Palliat Med. 2017;31(10):932–45. https://​doi.​org/​10.​1177/​0269216317705099​.CrossRefPubMed
11.
Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, et al. Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data. Curr Oncol. 2015;22(5):341–55.CrossRef
12.
Barbera L, Paszat L, Chartier C. Indicators of poor quality end-of-life cancer care in Ontario. J Palliat Care. 2006;22(1):12–7.PubMed
13.
Amblas-Novellas J, Murray SA, Espaulella J, Martori JC, Oller R, Martinez-Munoz M, et al. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories. BMJ Open. 2016;6(9):e012340.CrossRef
14.
Morris JN, Bernabei R, Ikegami N, Gilgen R, Frijters D, Hirdes JP, et al. RAI-Home Care (RAI-HC) assessment manual for version 2.0. Washington, DC: interRAI Corporation; 1999.
15.
Berg K, Mor V, Morris J, Murphy K, Moore T, Harris Y. Identification and evaluation of existing nursing homes quality indicators. HCFR. 2002;23(4):19–36.
16.
Hirdes JP, Fries BE, Morris JN, Ikegami N, Zimmerman D, Dalby DM, et al. Home care quality indicators (HCQIs) based on the MDS-HC. Gerontologist. 2004;44(5):665–79.CrossRef
17.
Morris JN, Jones RN, Fries BE, Hirdes JP. Convergent validity of minimum data set-based performance quality indicators in postacute care settings. Am J Med Qual. 2004;19(6):242–7.CrossRef
18.
Perlman CM, Hirdes JP, Barbaree H, Fries BE, McKillop I, Morris J, et al. Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res. 2013;13:15.CrossRef
19.
Carpenter GI, Hirdes JP. Using interRAI assessment systems to measure and maintain quality in long term care. A good life in old age? Monitoring and improving quality in long-term care. Paris: OECD/European Commission; 2013. p. 93–139.
20.
Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care. 2000;38(12):1184–90.CrossRef
21.
Hirdes JP, Ljunggren G, Morris JN, Frijters DH, Finne-Soveri H, Gray L, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8(277):1–11.
22.
Ontario Ministry of Health and Long-Term Care. Choosing quality, rewarding excellence: Ontario's response to the Caplan report of home care. Toronto: Ontario Ministry of Health and Long-Term Care; 2006.
23.
Hirdes JP, Frijters DH, Teare GF. The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people. J Am Geriatr Soc. 2003;51(1):96–100.CrossRef
24.
Hirdes JP, Poss JW, Mitchell L, Korngut L, Heckman G. Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings. PLoS One. 2014;9(6):e99066.CrossRef
25.
Armstrong JJ, Stolee P, Hirdes JP, Poss JW. Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age Ageing. 2010;39(6):755–8.CrossRef
26.
Hawes C, Fries BE, James ML, Guihan M. Prospects and pitfalls: use of the RAI-HC assessment by the department of veterans affairs for home care clients. Gerontologist. 2007;47(3):378–87.CrossRef
27.
Cook RJ, Berg KB, Lee KA, Poss JW, Hirdes JP, Stolee P. Rehabilitation in home care is associated with functional improvement and preferred discharge. Phys Med Rehabil. 2013;94(6):1038–47.CrossRef
28.
Kim H, Jung YI, Sung M, Lee JY, Yoon JY, Yoon JL. Reliability of the interRAI Long Term Care Facilities (LTCF) and interRAI Home Care (HC). Geriatr Gerontol Int. 2015;15(2):220–8.CrossRef
29.
Morris JN, Carpenter I, Berg K, Jones RN. Outcome measures for use with home care clients. Can J Aging. 2000;19(suppl 2):87–105.CrossRef
30.
Leung DY, Leung AY, Chi I. An evaluation of the factor structure of the instrumental activities of daily living involvement and capacity scales of the minimum data set for home care for elderly Chinese community dwellers in Hong Kong. Home Health Care Serv Q. 2011;30(3):147–59.CrossRef
31.
Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54A(11):M546–M53.CrossRef
32.
Morris JN, Fries BE, Mehr DR, Hawes C, Mor V, Lipsitz LMDS. Cognitive performance scale. J Gerontol A Biol Sc Med Sci. 1994;49(4):M174–M82.CrossRef
33.
Burrows AB, Morris JN, Simon SE, Hirdes JP, Phillips CD. Development of an MDS-based depression rating scale for use in nursing homes. Age Ageing. 2000;29:165–72.CrossRef
34.
Martin L, Poss JW, Hirdes JP, Jones RN, Stones MJ, Fries BE. Predictors of a new depression diagnosis among older adults admitted to complex continuing care: implications for the depression rating scale (DRS). Age Ageing. 2008;37(1):51–6.CrossRef
35.
Koehler M, Rabinowitz T, Hirdes JP, Stones M, Carpenter GI, Fries BE, et al. Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr. 2005;5:1.CrossRef
36.
Glenny C, Stolee P. Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults:a review of the literature. BMC Geriatr. 2009;9(52):1471–2318.
37.
Zyczkowska J, Szczerbinska K, Jantzi MR, Hirdes JP. Pain among the oldest old in community and institutional settings. Pain. 2007;129:167–76.CrossRef
38.
Fries BE, Schneider D, Foley WJ, Gavazzi M, Burke R, Cornelius E. Refining a case-mix measure for nursing homes: resource utilization groups (RUG-III). Med Care. 2001;32(7):668–85.CrossRef
39.
Mofina AM. Guthrie DM. A comparison of home care quality indicator rates in two Canadian provinces. BMC Health Serv Res. 2014;14(37):1–11.
40.
Dalby DM, Hirdes JP, Fries BE. Risk adjustment methods for home care quality indicators (HCQIs) based on the minimum data set for home care. BMC Health Serv Res. 2005;5(1):1–12.CrossRef
41.
Mor V, Berg K, Angelelli J, Gifford D, Morris J, Moore T. The quality of quality measurement in US nursing homes. Gerontologist. 2003;43(special issue II):37–46.CrossRef
42.
Todd K, Funk K, Funk J, Bonecci R. Cinical significance in reported changes in pain severity. Ann Emerg Med. 1996;27(4):485–9.CrossRef
43.
Lustman PJ, Griffith LS, Freedland KE, Kissel SS, Clouse RE. Cognitive behaviour therapy for depression in type 2 diabetes mellitus. Ann Intern Med. 1998;129(8):613–21.CrossRef
44.
Iezzoni LI. Risk adjustment for measuring health care outcomes; 2003.
45.
Perlman CM. Development of quality indicators for inpatient mental healthcare: strategy for risk adjustment [dissertation]. Waterloo: University of Waterloo; 2009.
46.
Dy SM, Kiley K, Ast K, Lupu D, Norton S, Mcmillan SC, et al. Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of hospice and palliative medicine and palliative nurses association. J Pain Symptom Manag. 2015;49(4):773–81.CrossRef
47.
Woitha K, Van Beek K, Ahmed N, Hasselaar J, Mollard JM, Colombet I, et al. Development of a set of process and structure indicators for palliative care: the Europall project. BMC Health Serv Res. 2012;12(1):1–12.CrossRef
48.
Anderson EW, Frazer MS, Schellinger SE. Expanding the palliative care domains to meet the needs of a community-based supportive care model. Am J Hosp Palliat Care. 2017;35:1–8.
49.
Potter J, Hami F, Bryan T, Quigley C. Symptoms of 400 patients referred to palliative care services: prevalence and patterns. Palliat Med. 2003;17(4):310–4.CrossRef
50.
Fisher KA, Seow H, Declercq A, Freeman S, Cohen J, Guthrie DM. Patient characteristics associated with prognostic awareness: a study on a Canadian palliative care population using the interRAI palliative care instrument. J Pain Symptom Manag. 2015;49:716–25.CrossRef
51.
Vitaliano PP, Scanlan JM, Zhang J. Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull. 2003;129(6):946–72.CrossRef
52.
Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, et al. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med. 2008;148(2):147–59.CrossRef
53.
Fitzsimons C, Mullen D, Wilson JS, Conway B, Corcoran B, Dempster M, et al. The challenge of patients’ unmet palliative care needs in the final stages of chronic illness. Palliat Med. 2007;21(4):313–22.CrossRef
54.
Paetkau S, Switzer G, Kasperki J, Seow H, Firth R, Adler L, et al. Advancing high quality, high value palliative care in Ontario: declaration of partnership and commitment to action. Toronto: Ontario Local Health Integration Networks; 2013.
55.
World Health Organization. Better palliative care for older people. Geneva: SUI; 2004.
56.
De Lima L, Bennett MI, Murray SA, Hudson P, Doyle D, Bruera E, et al. International Association for Hospice and Palliative Care (IAHPC) list of essential practices in palliative care. J Pain Palliat Care Pharmacother. 2012;26(2):118–22.CrossRef
57.
Kunkel S, Rosenqvist U, Westerling R. The structure of quality systems is important to the process and outcome, an empirical study of 386 hospital departments in Sweden. BMC Health Serv Res. 2007;7(1):104.CrossRef
58.
59.
Metadata
Title
Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for Ontario
Authors
Lisa E. Harman
Dawn M. Guthrie
Joachim Cohen
Anja Declercq
Kathryn Fisher
Donna Goodridge
John P. Hirdes
Hsien Seow
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2019
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-018-0389-y

Other articles of this Issue 1/2019

BMC Palliative Care 1/2019 Go to the issue

Research article

Completion rate of physician orders for life-sustaining treatment for patients with metastatic or recurrent cancer: a preliminary, cross-sectional study

Research article

Action research study on advance care planning for residents and their families in the long-term care facility

Research article

Palliative care for persons with Parkinson’s disease: a qualitative study on the experiences of health care professionals

Research article

What do patients and family-caregivers value from hospice care? A systematic mixed studies review

Research article

Palliative care for patients with motor neurone disease and their bereaved carers: a qualitative study

Research article

How to come to terms with facing death: a qualitative study examining the experiences of patients with terminal Cancer