Long-term Care Public Reporting Website Technical Report
The purpose of the Technical Report is to provide public access to details of the process used to generate indicator results. This information will be useful to others interested in replicating the indicators presented on the HQO long-term care website. Further details on the process and methods used to select the indicators on HQO's long- term care reporting website can be obtained from HQO.
The indicator results presented were provided to HQO by several sources including the Canadian Institute for Health Information (CIHI), the Institute for Clinical Evaluative Sciences (ICES), the Ministry of Health and Long Term Care (MOHLTC) and the Workplace Safety and Insurance Board (WSIB). A brief glossary for the data sources used to produce the indicators is provided below.
Registered Persons Data Base (RPDB)
The RPDB provides basic demographic information about anyone who has ever received an Ontario health card number. Data supplied to ICES by MOHLTC is enriched with information from other ICES data sets.
Ontario Drug Benefit (ODB) plan
Each time a prescription is dispensed under the ODB program a claim is submitted to the ODB for payment. This claim contains information on the drug dispensed. The ODB data used in the report were limited to claims for individuals 65 years of age and over. The data is supplied to ICES by the MOHLTC.
Discharge Abstract Databases (DAD)
The DAD is a data collection tool developed by CIHI to collect information on patients treated in acute care hospitals. Each time an individual is discharged from an acute care hospital the hospital submits to CIHI an electronic record that contains patient demographic, diagnostic and treatment data. The DAD is supplied to ICES by CIHI.
National Ambulatory Care Reporting System (NACRS)
NACRS is a data collection tool developed by CIHI to capture information on patient visits to emergency departments. The NACRS data used in this report are collected on a routine basis by all emergency departments (ED) in Ontario. NACRS is supplied to ICES by CIHI.
Resident Assessment Instrument — Minimum Data Set (RAI-MDS)
The Resident Assessment Instrument – Minimum Data Set (RAI-MDS) is one of the interRAI instruments implemented to improve the care of frail elderly and disabled adults in chronic care and institutional long-term care homes by standardizing the assessment and care planning process. Each assessment form incorporates each individual’s strengths, preferences and needs by incorporating key domains of function, mental and physical health, social support and service use into the assessment. The results from the assessment can be used by the care team to provide an in-depth care plan that is personally tailored to each resident’s needs. RAI-MDS has been implemented in more than 30 countries, as well as several provinces and territories in Canada for purposes such as care planning, facility management, needs assessment, policy development, quality improvement and benchmarking, reimbursement, research, or service eligibility.
What is risk adjustment?
Just as communities across Canada vary in their age distribution, variation also occurs in other socio-demographic and health characteristics that can greatly influence health status and the need for and use of health services. Early generations of quality indicators for the RAI-MDS were developed in the U.S. and focused primarily on prevalence measures with basic or no risk adjustment. However, over time statistical methodologies in risk adjustment were developed to modify a 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. Therefore, risk-adjusted RAI-MDS quality indicators allow for fairer comparisons to be made across long-term care homes and to provide a mechanism for homes to identify priority areas of impact for quality improvement efforts and a platform to share resources. In addition, benchmarking and standards can be developed over time.