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System Performance

Measuring Long-Term Care Home Performance in Ontario

Long-term care home administrators, home operators, measurement experts, long-term care home resident councils, and other sector experts in Ontario have reviewed existing and new quality indicators and made recommendations for public reporting.

Read the indicator review report

Benchmarks for performance have been developed for some of the long-term care home indicators. These benchmarks are used for local target setting for Quality Improvement Plans. Read the benchmarking report on long-term care homes.

Data Sources

Continuing Care Reporting System

The Canadian Institute for Health Information CIHI) developed the Continuing Care Reporting System to enhance the collection of standardized facility-based long-term care and complex continuing care information for national comparative reporting. The Continuing Care Reporting System contains demographic, administrative, clinical and resource utilization information on individuals receiving continuing care services in hospitals or in long-term care homes in Canada. Participating organizations also provide information on facility characteristics to support comparative reporting.

The clinical data are collected using an internationally accepted standard, the Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS 2.0). Each resident in a long-term care home is assessed at admission and every three months or whenever they experience a significant change in health status. The RAI-MDS 2.0 assessment includes patient-level measures of function, mental and physical health, social support and service use. It was modified by the Canadian Institute of Health Information with permission for Canadian use. All long-term care homes in Ontario have submitted data to them on a quarterly basis since 2009.

Parts of these online indicators are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

Client Profile Database (CPRO) – Ministry of Health and Long-Term Care

The Client Profile Database (CPRO) contains patient-level application information for individuals placed or waiting to be placed in a long-term care home. The database includes three broad types of information: patient characteristics and location at application, long-term care home choices, and milestone (date) events throughout the long-term care home placement process. CPRO is the authoritative data source for long-term care home bed demand, patient placement and wait list data. The Health Shared Services Ontario submits patient-level data on behalf of each Local Health Integration Network on a monthly basis to support bed utilization monitoring, performance management and long-term care accountability planning. In the fall of 2016, a modernized CPRO was launched to improve data quality and timeliness. Modernized CPRO includes datasets from April 2012 and onward. Data from CPRO are housed by the Ministry of Health and Long-Term Care.

Risk Adjustments

When interpreting and comparing the results of quality indicators in different populations, regions or over time, it is important to account for the underlying differences in the populations being compared. We call this “risk adjustment” and it allows us to make a fair comparison across groups and to distinguish variation that is due to differences in practice. Results can be adjusted to account for differences in the age, sex, or other characteristics of people within a certain population.

Early generations of quality indicators for the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) were developed in the United States and focused primarily on prevalence indicators with basic or no risk adjustment. However, over time, statistical methodologies in risk adjustment were developed to modify a long-term care home’s raw quality indicator score by accounting for multiple differences in resident populations across facilities. Results are adjusted relative to a standard reference population. The risk adjustment factors include facility and resident characteristics, such as age and health status.

If you have a question about reporting on the performance of Ontario’s long-term care homes, please email us at systemperformance@hqontario.ca

Looking for Balance

A specialized report on the use of anti-psychotic medication on residents of long-term care homes

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Front cover of Looking for Balance - a specialized report about anti-psychotic medication use in long-term care homes in Ontario

Monitoring What Matters

Our approach to measuring and reporting on the performance of Ontario’s health system

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The Common Quality Agenda

A set of indicators to measure health quality in Ontario

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Indicator Library

Technical information on quality indicators; searchable and comparable data

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