delirium quality of careon the cihi reporting site and on the health quality ontario web page all...
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Quality of CareSOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016
Delirium
Assessment SelectionINDICATOR TYPES
1) Prevalence
2) Incidence◦ Improvement
◦ Decline
PREVELANCEAssessment was carried out more than 92 days from Admission Date
Assessment was not an Admission Full Assessment
only latest assessment in a quarter is used as long as it meets the criteria stated above
INCIDENCEAssessment was carried out more than 92 days from Admission Date
Assessment was not an Admission Full Assessment
only latest assessment in a quarter is used as long as it meets the criteria stated above
has an assessment in the previous quarter at least 45 days and no more than165 days
POPULATION RISK ADJUSTMENTFactors beyond the facility’s control may effect a given outcome.
A facility may have a given score on a QI due to the fact that they may have higher or lower risk residents.
To account for these uncontrolled difference statistical adjustments are utilized in the RAI QI calculations.
ROLLING FOUR QUARTER AVERAGEOn the CIHI reporting site and on the Health Quality Ontario web page all results are based on 12 months of assessments.
Rolling Average for Prevalence Indicators
SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016, Page 55
Rolling Average for Incidence Indicators
SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016, Page 55
TWELVE PREVELANCE INDICATOR1 Has a feeding tube
2 Has a new stage 2 to 4 pressure ulcer
3 Has a stage 2 to 4 pressure ulcer
4 Has an indwelling catheter
5 Has Daily physical restraints
6 Has fallen
7 Has had weight loss
8 Has one or more infections
9 Has pain
10 Has symptoms of delirium
11 Has Taken antipsychotics without a diagnosis of psychosis
12 Has urinary tract infection
NINE IMPROVEMENT INDICATORS1 Improved behavioural symptoms
2 Improved bladder continence
3 Improved bowel continence
4 Improved cognitive ability
5 Improved communication ability
6 Improved late-loss ADL
7 Improved locomotion
8 Improved or remained independent in early-loss ADL
9 Improved or remained independent in mid-loss ADL
FOURTEEN DECLINE INDICATORS1 Worsened ADL
2 Worsened behavioural symptoms
3 Worsened bladder continence
4 Worsened bowel continence
5 Worsened cognitive ability
6 Worsened communication ability
7 Worsened late-loss ADL
8 Worsened locomotion
9 Worsened mood from symptoms of depression
10 Worsened or remained dependent in early-loss ADL
11 Worsened or remained dependent in mid-loss ADL
12 Worsened pain
13 Worsened stage 2 to 4 pressure ulcer
14 Worsened/unchanged respiratory condition
Table 1: Top 13 Quality Indicator including Health Quality Ontario 9 Indicators, Ontario 2014 Quarter 4 Results, Top Indicator most Sensitive to Care with a Mapping to the corresponding RAP.
Indicator Type Indicator Group Specific Indicator with 2014 Q4 Bench Mark
Health Quality Ontario
Benchmark
Ontario 2017
Quarter 1
*Sensitive to Practice Rank TOP 13 Areas
RAP DescriptionRAP /CAP Number
Incidence (Decline) Other Clinical Issues Worsened ADL 25.00%33.37
ADL Rehab Potential 5
Incidence (Decline) Psychosocial Function Worsened behavioural symptoms 8.00%13.4
7 Behavioural Symptoms 9
Incidence (Decline) Psychosocial Function Worsened bladder continence 12.00%18.5
Urinary Incontinence and Indwelling Catheter
6
Incidence (Decline) Psychosocial Function Worsened mood from symptoms of depression 13.00%23.5
12.5 Mood State 8
Incidence (Decline) Physical Function Worsened pain 6.00%10,24
2 Pain (MED e-care Software) 20
Incidence (Decline) Physical Function Worsened stage 2 to 4 pressure ulcer 1.00%3.30
1 Pressure Ulcer 16
Prevalence Safety Has a new stage 2 to 4 pressure ulcer 1.00%3.01
1 Pressure Ulcer 16
Prevalence Psychosocial Function Has Daily physical restraints 3.00%5.13
3.5 Physical Restraints 18
Prevalence Safety Has fallen 9.00%15.49
10 Falls 11
PrevalencePhysical Function
Has symptoms of delirium 13.89 6 Delirium 1/Y
Prevalence Other Clinical Issues Has Taken antipsychotics without a diagnosis of psychosis 19.00%20.17
3.5 Psychotropic Drug Use 17
Prevalence Physical Function Has weight loss6.39
12.5 Nutritional Status 12
*Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data Carole A Estabrooks1*, Jennifer A Knopp-Sihota12 and Peter G Norton3
DEFINITIONS: Cognitive Performance Scale CPS0 = Intact1 = Borderline intact2 = Mild impairment3 = Moderate impairment4 = Moderate severe impairment5 = Severe impairment6 = Very severe impairment
Cognitive Impairment = 0 to 3
IF Decision Making (B4) = [Modified Independence 1, OR Moderately Impaired 2] THEN Cognitive Impairment = Cognitive Impairment + 1
IF MAKING SELF UNDERSTOOD C4 = [Usually Understood 1, OR Sometimes Understood 2, OR Rarely or Never Understood 3] THEN Cognitive Impairment = Cognitive Impairment + 1
IF Short Term Memory B2a = Memory Problem 1 THEN Cognitive Impairment = Cognitive Impairment + 1
Booth, Jack H.. "Delirium." Gale Encyclopedia of Mental Disorders. 2003. Retrieved November 17, 2015 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405700108.html
DEFINITIONS: Cognitive Performance Scale CPS0 = Intact1 = Borderline intact2 = Mild impairment3 = Moderate impairment4 = Moderate severe impairment5 = Severe impairment6 = Very severe impairment
Severe Cognitive Impairment = 0 to 2
IF Decision Making (B4) = [Moderately Impaired 2] THEN Severe Cognitive Impairment = Severe Cognitive Impairment + 1
IF MAKING SELF UNDERSTOOD C4 = [Sometimes Understood 2, OR Rarely or Never Understood 3] THEN Severe Cognitive Impairment = Severe Cognitive Impairment + 1
DEFINITIONS: Cognitive Performance Scale CPS0 = Intact 1 = Borderline intact 2 = Mild impairment 3 = Moderate impairment
4 = Moderate severe impairment 5 = Severe impairment 6 = Very severe impairment
Cognitive Performance Scale = 0 to 6CPS score:IF Comatose B1 = Yes OR (Decision Making B4 = Severely Impaired 3 AND Eating Performance G1ha = [Total 4, Absent 8]) THEN CPS = Very severe impairment 6ELSE IF Comatose B1 = No AND Decision Making B4 = Severely Impaired 3 AND Eating Performance G1ha = [0, 1, 2, 3] THEN CPS = Severe impairment 5ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 2 THEN CPS = Moderate severe impairment 4ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 1 THEN CPS = Moderate impairment 3ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 0 THEN CPS = Mild impairment 2ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = 1 THEN CPS = Borderline intact 1ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = 0 THEN CPS = Intact 0
B4 = Independent 0 OR Modified Independence 1, OR Moderately Impaired 2 OR Severely Impaired 3
EXCLUSIONS
DEL0X—Percent of residents with symptoms of deliriumB1_COMATOSE_IND_CODE = YesJ5C_END_STAGE_DISEASE = YesP1AO_HOSPICE_CARE = Yes
TRIGGERS FOR THE QUALITY INDICATOR - CPS
TRIGGERS FOR THE QUALITY INDICATOR
CALCULATION
DEL0X—Percent of residents with symptoms of delirium
THERE ARE 3 WAYS TO TRIGGER THE DELIRIUM QUALITY INDICATOR
CALCULATION NUMBER 1
If any one of the items on the Current Assessment was scored:
Behaviour present, over last 7 days appears different from resident’s usual functioning (e.g. new onset or worsening)IF ( B5A_EASILY_DISTRACTED = new onset or worsening 2 OR B5B_PERIODS_OF_ALT_PERCEPT = new onset or worsening 2 OR B5C_EPISODES_OF_DISORG_SPEECH = new onset or worsening 2OR B5D_PERIODS_OF_RESTLESSNESS = new onset or worsening 2OR B5E_PERIODS_OF_LETHARGY = new onset or worsening 2OR B5F_MENTAL_FUNCTION_VARIES = new onset or worsening 2)
CALCULATION NUMBER 2
On the current assessment Behaviour present, not of recent onset AND
On the prior assessment Behaviour present, over last 7 days appears different from resident’s usual functioning (e.g. new onset or worsening)
( Recent B5A_EASILY_DISTRACTED = 1 AND PRIOR_B5a = 2OR Recent B5B_PERIODS_OF_ALT_PERCEPT = 1 AND PRIOR_B5b = 2 OR Recent B5C_EPISODES_OF_DISORG_SPEECH = 1 AND PRIOR_B5c = 2OR Recent B5D_PERIODS_OF_RESTLESSNESS = 1 AND PRIOR_B5d = 2OR Recent B5E_PERIODS_OF_LETHARGY = 1 AND PRIOR_B5e = 2OR Recent B5F_MENTAL_FUNCTION_VARIES = 1 AND PRIOR_B5f = 2)
CALCULATION NUMBER 3NOTE: In the 3rd potential trigger the Cognitive Performance Score (CPS) becomes part of the calculation. The CPS score for the resident must indicate that the resident is no more than moderately impaired (i.e. a score of 3 or less on the CPS).
On the current assessment Behaviour present, not of recent onset AND
On the prior assessment Behaviour not presentAND
On the current CPS A score of 3 or less(( Recent B5A_EASILY_DISTRACTED = 1 AND PRIOR_B5a = 0OR Recent B5B_PERIODS_OF_ALT_PERCEPT = 1 AND PRIOR_B5b = 0 OR Recent B5C_EPISODES_OF_DISORG_SPEECH = 1 AND PRIOR_B5c = 0OR Recent B5D_PERIODS_OF_RESTLESSNESS = 1 AND PRIOR_B5d = 0OR Recent B5E_PERIODS_OF_LETHARGY = 1 AND PRIOR_B5e = 0OR Recent B5F_MENTAL_FUNCTION_VARIES = 1 AND PRIOR_B5f = 0
))AND_CPS_cc_in_(0,1,2,3) 0 = Intact 1 = Borderline intact 2 = Mild impairment 3 = Moderate impairment
CALCULATION SUMMARY
Current
Not Present 0 Not Recent 1
Recent or Worse 2
Not Present 0 No Yes CPS 0,1,2,3 Yes
Prior Not Recent 1 No No YesRecent or Worse 2 No Yes Yes
SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016
RAP
CAP
ReferencesinterRAI, Canadian Institute for Health Information - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016 http://cihi.ca
Canadian Institute for Health Information, HCC Medication List, 2015–2016 (For Use With CCRS and HCRS), Http://cihi.ca
Canadian Institute for Health Information, Your Health System, http://yourhealthsystem.cihi.ca/
Canadian Institute for Health Information, Resident Assessment Instrument (RAI) RAI-MDS 2.0 User’s Manual, Canadian Version, February 2012, Http://cihi.ca
Health Quality Ontario, http://www.hqontario.ca/public-reporting/long-term-care
Alberta Health, RAI-MDS 2.0 Quality Indicator Interpretation Guide, May 2015, http://www.health.alberta.ca/documents/CC-CIHI-RAI-Guide-2015.pdf
Canadian Institute for Health Information, CCRS Quality Indicators Risk Adjustment Methodology, 2013, https://www.cihi.ca/en/ccrs_qi_risk_adj_meth_2013_en.pdf.
interRAI, Http://interRAI.org