The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project)

Frijters, Dinnus HM; van der Roest, Henriëtte G; Carpenter, Iain GI; Finne-Soveri, Harriet; Henrard, Jean-Claude; Chetrit, Angela; Gindin, Jacob; Bernabei, Roberto

doi:10.1186/1472-6963-13-138

BMC Health Services Research

Table 1 Quality indicators for the interRAI LTCF instrument

From: The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project)

# ¹	Indicator	Numerator ²	Denominator exclusions ³	Risk adjustment	FAP ⁴
Prevalence indicators
Mental functions
beh01	Behaviour problem prevalence ⁵	Behaviour symptoms	Comatose.		+
beh02	High risk behaviour problem prevalence	Behaviour symptoms	Comatose.		+
			Low risk behaviour (see beh03)
beh03	Low risk behaviour problem prevalence	Behaviour symptoms	Comatose.		+
			Dependent in daily decision making or short term memory problem. Schizophrenic or bipolar depression.
dep01	Depression prevalence	Depression Ration Scale score > = 3
Health problems
cnt01	Bladder/bowel incontinence prevalence	Frequent or always bladder or bowel incontinent	Comatose, end-stage disease or hospice care.		+
cnt05	High risk bladder/bowel incontinence prevalence	Frequent or always bladder or bowel incontinent	Comatose, end-stage disease or hospice care.		+
			Low risk incontinence (see cnt06)
cnt06	Low risk bladder/bowel incontinence prevalence	Frequent or always bladder or bowel incontinent	Comatose, end-stage disease or hospice care.		+
			Severely impaired decision making and short term memory problem.
			Total ADL dependence in bed mobility, transfer toilet or locomotion.
cnt04	Urinary tract infection	UTI	End-stage disease or hospice care.
inf01	Infections prevalence	Pneumonia, COPD, septicemia, Sexually transmitted disease, UTI or viral hepatitis	End-stage disease or hospice care.		+
nut01	Feeding tube prevalence		Comatose, end-stage disease or hospice care.	(1) Swallowing problem and stroke	+
bmi0x	Low body mass index prevalence	bmi < = 19	End-stage disease or hospice care.		+
pai01	Inadequate pain management prevalence	Daily moderate or worse pain		(1) Dependent in daily decision making	+
pru01	Pressure ulcer prevalence	PU			+
pru02	High risk pressure ulcer prevalence	PU	Comatose.		+
			Low risk PU (see pru03)
pru03	Low risk pressure ulcer prevalence	PU	Comatose.		+
			Extensive assistance or more with toilet transfer or bed mobility.
bur0x	Burns, skin tears or cuts prevalence	Burns, skin tears or cuts			+
Treatments and procedures
soc02	Little/no activity prevalence	Little or no time involved in activities	Comatose, end-stage disease or hospice care.
drg01	Antipsychotic prevalence	Use of antipsychotic(s)	End-stage disease or hospice care.		+
			Psychotic disorder.
drg02	High risk antipsychotic prevalence	Use of antipsychotic(s)	End-stage disease or hospice care.		+
			Low risk AP (see drg03)
drg03	Low risk antipsychotic prevalence	Use of antipsychotic(s)	End-stage disease or hospice care.		+
			Psychotic disorder.
			Dependent in daily decision making.
			Short term memory problem.
			Behaviour symptoms score.
adp01	Antidepressant prevalence	Use of antidepressant(s)			+
vac01	Influenza vaccination prevalence	Influenza vaccination in last 12 months
cat02	Indwelling catheter prevalence	Indwelling catheter	End-stage disease or hospice care.	(1) Frequent or always bowel incontinent
				(2) Stage 3+ PU
res01	Physical restraints use prevalence	Daily used trunk restraint or chair that prevents rising
Incidence indicators
Physical functions
adl01	Late-loss ADL decline	Scores as compared to previous scores ⁶ for bed mobility, transfer toilet, eating, toilet use: +1 on at least two of the items or +2 on one item.	Comatose, end-stage disease or hospice care.
			At previous assessment such a (high/low) score on items that numerator conditions cannot be met. ⁷
adl02	ADL decline following an improvement	Score on adl-lf ⁸ lower than previous AND score on previous adl-lf higher than at the assessment before previous.	Comatose, end-stage disease or hospice care.
adl03	ADL improvement	Score on adl-lf lower than previous	Comatose, end-stage disease or hospice care.
			Person or caregivers do not believe improvement possible.
mob01	Locomotion worsening	Score on locomotion adl higher than previous	Comatose, end-stage disease or hospice care.	(1) Fell	+
				(2) Extensive assistance eating
				(3) Extensive assistance toilet use
fal01	Falls increase	Fell in last 30 days	At previous assessment not a fall in last 30 days	(1) Bedbound
				(2) Wandering behaviour
				(3) Unsteady gait and cps > =2
Mental functions
cog01	Cognitive decline	Score on cps higher than previous	Comatose, end-stage disease or hospice care.	(1) Frequent or always bowel incontinent	+
				(2) Fell in last 30 days
				(3) Weight loss
				(4) 76+ years old
com01	Communication decline	Score on making self understood + ability to understand others higher than previous	Comatose, end-stage disease or hospice care.	(1) Extensive assistance eating	+
				(2) Short term memory
del01	Delirium new or persistent	Score of 2 on one or more of the delirium items OR a previous score of 2 and now 1 OR now score of 1 and cps < 4	Comatose, end-stage disease or hospice care.		+
beh04	Behaviour problem decline	Sum of behaviour symptoms scores higher than previous	Comatose	(1) Not aphasia	+
			Previous score of 0 on all of the behaviour symptoms	(2) Moderate or severe decision making problem
Health problems
cnt02	Bowel continence decline	Score on bowel incontinence higher than previous	Comatose, end-stage disease or hospice care.	(1) Short term memory
				(2) Extensive assistance dressing
				(3) Frequent or always bladder incontinent
cnt03	Bladder continence decline	Score on bladder incontinence higher than previous	Comatose, end-stage disease or hospice care.	(1) Short term memory	+
				(2) Extensive assistance dressing
				(3) Severely impaired decision making
				(4) Weight loss
wgt01	Weight loss	5% or more weight loss in last 30 days or 10% or more in last 180 days	End-stage disease or hospice care.	(1) Long term memory	+
			Participant in weight loss program.	(2) Extensive assistance bed mobility
				(3) Daily or almost daily physically aggressive
pan01	Pain worsening	Score on pain frequency higher than previous		(1) Dependent in daily decision making	+
pru04	Pressure ulcers worsening	Score on PU stage higher than previous		(1) Extensive assistance with toilet transfer	+
				(2) Fluctuating, precarious, deteriorating condition
				(3) Extensive assistance with bed mobility
				(4) Extensive assistance with locomotion
Treatments and procedures
cat01	New indwelling catheter	Score on indwelling catheter higher than previous	End-stage disease or hospice care.	(1) Frequent or always bowel incontinent
				(2) Stage 3+ Pressure Ulcer

¹ Mnemonics for the quality indicators from megaQI project [5].
² The ADL’s with a 0 – 6 range in the interRAI LTCF have first been recoded into a 0 – 4 range as in RAI/MDS 2.0.
³ Condition at target assessment unless stated differently.
⁴ FAP = Facility Admission Profile. FAP-adjustment means correction on the basis of score of the numerator items at admission, if admission occurred in last five quarters.
⁵ All prevalence indicators are calculated at only one, the last, assessment where the person had stayed 30+ days in the facility.
⁶ When an assessment is compared with a previous assessment 6 assessments can be considered, i.e. the target assessment as compared to the previous one; the previous one as compared to the one before that, and so on. It means that in theory a person can be counted 5 times in the calculation of a QI.
⁷ This condition or a similar condition applies to all of the indicators.
⁸ The following scales are used: adl-long form [16], cognitive performance scale [17] and depression rating scale [18].

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