P-8: The Development of Quality Indicators for Seriously-ill Home Care Clients in Ontario
Lisa Harman,* Nicole Williams, Dr. Dawn Guthrie
Wilfrid Laurier University
The objective of this research was to develop preliminary quality indicators (QIs) for seriously-ill home care clients.
Secondary analysis of Resident Assessment Instrument for Home Care (RAI-HC) data from 2006-2013 (n=263,767) was used to develop QIs thought to be relevant to the needs of seriously-ill (SI) home care clients. SI clients were defined as having a prognosis of 6 months or less and a high level of health instability indicated by the CHESS scale. Consultations with subject matter experts (SMEs) took place to gain insight as to what was important to measure for SI clients. Client-level risk adjustment was performed on the QIs that the SMEs deemed appropriate. The rates of the created QIs were stratified across local health integration networks (LHINs) to examine regional variations across Ontario.
A preliminary set of QIs were modified after the SME consultations were completed. A total of eight quality indicators were developed for use with the RAI-HC, two with client-level risk adjustment. QIs with the highest rates were prevalence of shortness of breath (66.2%), prevalence of falls (49.0%) and prevalence of daily pain (46.6%). The northern regions of Ontario had higher rates than the Central regions for six out of eight of the QIs, indicating that the northern regions of Ontario may be performing worse than the central regions.
Hospice palliative care services in Ontario are undergoing a process of restructuring. This research can assist in understanding where potential quality issues exist, which can ultimately contribute to quality improvement initiatives in this sector.