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

BMC Palliative Care

Donna Goodridge¹  Lisa E. Harman²  Dawn M. Guthrie²  Joachim Cohen³  Hsien Seow⁴  Anja Declercq⁵  Kathryn Fisher⁶  John P. Hirdes⁷ 

[1] College of Medicine, University of Saskatchewan;Department of Kinesiology and Physical Education, Wilfrid Laurier University;End-of-Life Care Research Group, Faculty of Medicine, Vrije Universiteit Brussel;Juravinski Cancer Centre;LUCAS-Centre for Care Research and Consultancy, K.U. Leuven;School of Nursing, McMaster University;School of Public Health & Health Systems, University of Waterloo;

关键词: Quality indicators;    Quality measures;    Palliative care;    Seriously ill;    InterRAI;    End-of-life care;   

DOI  :  10.1186/s12904-018-0389-y

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown