Long-term Care Public Reporting Website Technical Report
The purpose of this Technical Report is to provide details on the process used to generate indicator results. This information will be useful to others interested in replicating the long-term care indicators reported online on Health Quality Ontario (HQO)’s website. HQO can provide additional details on the process and methods used to select the indicators reported online.
The indicator results reported 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 (the ministry) and the Workplace Safety and Insurance Board (WSIB). Here is a brief glossary of the data sources used to produce the indicators:
Registered Persons Database (RPDB)
The RPDB provides basic demographic information about anyone who has ever received an Ontario health card number. Data supplied to ICES by the ministry is enriched with information from other ICES datasets.
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 for reporting is limited to claims for people 65 years of age and over. The data is supplied to ICES by the ministry.
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 someone is discharged from an acute care hospital, the hospital submits an electronic record to CIHI that contains patient demographic, diagnostic and treatment data. CIHI supplies the DAD to ICES.
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 online public reporting are collected on a routine basis by all emergency departments in Ontario. CIHI supplies the NACRS to ICES.
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 captures every person’s strengths, preferences and needs by incorporating the key domains of function, mental and physical health, social support and service use. 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 and 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 United States 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, provide a mechanism for homes to identify priority areas of impact for quality improvement efforts, and platforms to share resources. In addition, benchmark values are only available for the risk-adjusted indicators on HQO’s webpages.