Quality of CareSOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016

Delirium

Assessment SelectionINDICATOR TYPES

1) Prevalence

2) Incidence◦ Improvement

◦ Decline

PREVELANCEAssessment was carried out more than 92 days from Admission Date

Assessment was not an Admission Full Assessment

only latest assessment in a quarter is used as long as it meets the criteria stated above

INCIDENCEAssessment was carried out more than 92 days from Admission Date

Assessment was not an Admission Full Assessment

only latest assessment in a quarter is used as long as it meets the criteria stated above

has an assessment in the previous quarter at least 45 days and no more than165 days

POPULATION RISK ADJUSTMENTFactors beyond the facility’s control may effect a given outcome.

A facility may have a given score on a QI due to the fact that they may have higher or lower risk residents.

To account for these uncontrolled difference statistical adjustments are utilized in the RAI QI calculations.

ROLLING FOUR QUARTER AVERAGEOn the CIHI reporting site and on the Health Quality Ontario web page all results are based on 12 months of assessments.

Rolling Average for Prevalence Indicators

SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016, Page 55

Rolling Average for Incidence Indicators

SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016, Page 55

TWELVE PREVELANCE INDICATOR1 Has a feeding tube

2 Has a new stage 2 to 4 pressure ulcer

3 Has a stage 2 to 4 pressure ulcer

4 Has an indwelling catheter

5 Has Daily physical restraints

6 Has fallen

7 Has had weight loss

8 Has one or more infections

9 Has pain

10 Has symptoms of delirium

11 Has Taken antipsychotics without a diagnosis of psychosis

12 Has urinary tract infection

NINE IMPROVEMENT INDICATORS1 Improved behavioural symptoms

2 Improved bladder continence

3 Improved bowel continence

4 Improved cognitive ability

5 Improved communication ability

6 Improved late-loss ADL

7 Improved locomotion

8 Improved or remained independent in early-loss ADL

9 Improved or remained independent in mid-loss ADL

FOURTEEN DECLINE INDICATORS1 Worsened ADL

2 Worsened behavioural symptoms

3 Worsened bladder continence

4 Worsened bowel continence

5 Worsened cognitive ability

6 Worsened communication ability

7 Worsened late-loss ADL

8 Worsened locomotion

9 Worsened mood from symptoms of depression

10 Worsened or remained dependent in early-loss ADL

11 Worsened or remained dependent in mid-loss ADL

12 Worsened pain

13 Worsened stage 2 to 4 pressure ulcer

14 Worsened/unchanged respiratory condition

Table 1: Top 13 Quality Indicator including Health Quality Ontario 9 Indicators, Ontario 2014 Quarter 4 Results, Top Indicator most Sensitive to Care with a Mapping to the corresponding RAP.

Indicator Type Indicator Group Specific Indicator with 2014 Q4 Bench Mark

Health Quality Ontario

Benchmark

Ontario 2017

Quarter 1

*Sensitive to Practice Rank TOP 13 Areas

RAP DescriptionRAP /CAP Number

Incidence (Decline) Other Clinical Issues Worsened ADL 25.00%33.37

ADL Rehab Potential 5

Incidence (Decline) Psychosocial Function Worsened behavioural symptoms 8.00%13.4

7 Behavioural Symptoms 9

Incidence (Decline) Psychosocial Function Worsened bladder continence 12.00%18.5

Urinary Incontinence and Indwelling Catheter

6

Incidence (Decline) Psychosocial Function Worsened mood from symptoms of depression 13.00%23.5

12.5 Mood State 8

Incidence (Decline) Physical Function Worsened pain 6.00%10,24

2 Pain (MED e-care Software) 20

Incidence (Decline) Physical Function Worsened stage 2 to 4 pressure ulcer 1.00%3.30

1 Pressure Ulcer 16

Prevalence Safety Has a new stage 2 to 4 pressure ulcer 1.00%3.01

1 Pressure Ulcer 16

Prevalence Psychosocial Function Has Daily physical restraints 3.00%5.13

3.5 Physical Restraints 18

Prevalence Safety Has fallen 9.00%15.49

10 Falls 11

PrevalencePhysical Function

Has symptoms of delirium 13.89 6 Delirium 1/Y

Prevalence Other Clinical Issues Has Taken antipsychotics without a diagnosis of psychosis 19.00%20.17

3.5 Psychotropic Drug Use 17

Prevalence Physical Function Has weight loss6.39

12.5 Nutritional Status 12

*Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data Carole A Estabrooks1*, Jennifer A Knopp-Sihota12 and Peter G Norton3

DEFINITIONS: Cognitive Performance Scale CPS0 = Intact1 = Borderline intact2 = Mild impairment3 = Moderate impairment4 = Moderate severe impairment5 = Severe impairment6 = Very severe impairment

Cognitive Impairment = 0 to 3

IF Decision Making (B4) = [Modified Independence 1, OR Moderately Impaired 2] THEN Cognitive Impairment = Cognitive Impairment + 1

IF MAKING SELF UNDERSTOOD C4 = [Usually Understood 1, OR Sometimes Understood 2, OR Rarely or Never Understood 3] THEN Cognitive Impairment = Cognitive Impairment + 1

IF Short Term Memory B2a = Memory Problem 1 THEN Cognitive Impairment = Cognitive Impairment + 1

Booth, Jack H.. "Delirium." Gale Encyclopedia of Mental Disorders. 2003. Retrieved November 17, 2015 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405700108.html

DEFINITIONS: Cognitive Performance Scale CPS0 = Intact1 = Borderline intact2 = Mild impairment3 = Moderate impairment4 = Moderate severe impairment5 = Severe impairment6 = Very severe impairment

Severe Cognitive Impairment = 0 to 2

IF Decision Making (B4) = [Moderately Impaired 2] THEN Severe Cognitive Impairment = Severe Cognitive Impairment + 1

IF MAKING SELF UNDERSTOOD C4 = [Sometimes Understood 2, OR Rarely or Never Understood 3] THEN Severe Cognitive Impairment = Severe Cognitive Impairment + 1

DEFINITIONS: Cognitive Performance Scale CPS0 = Intact 1 = Borderline intact 2 = Mild impairment 3 = Moderate impairment

4 = Moderate severe impairment 5 = Severe impairment 6 = Very severe impairment

Cognitive Performance Scale = 0 to 6CPS score:IF Comatose B1 = Yes OR (Decision Making B4 = Severely Impaired 3 AND Eating Performance G1ha = [Total 4, Absent 8]) THEN CPS = Very severe impairment 6ELSE IF Comatose B1 = No AND Decision Making B4 = Severely Impaired 3 AND Eating Performance G1ha = [0, 1, 2, 3] THEN CPS = Severe impairment 5ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 2 THEN CPS = Moderate severe impairment 4ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 1 THEN CPS = Moderate impairment 3ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = [2, 3] AND Severe Cognitive Impairment = 0 THEN CPS = Mild impairment 2ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = 1 THEN CPS = Borderline intact 1ELSE IF Comatose B1 = No AND B4 = [0, 1, 2] AND Cognitive Impairment = 0 THEN CPS = Intact 0

B4 = Independent 0 OR Modified Independence 1, OR Moderately Impaired 2 OR Severely Impaired 3

EXCLUSIONS

DEL0X—Percent of residents with symptoms of deliriumB1_COMATOSE_IND_CODE = YesJ5C_END_STAGE_DISEASE = YesP1AO_HOSPICE_CARE = Yes

TRIGGERS FOR THE QUALITY INDICATOR - CPS

TRIGGERS FOR THE QUALITY INDICATOR

CALCULATION

DEL0X—Percent of residents with symptoms of delirium

THERE ARE 3 WAYS TO TRIGGER THE DELIRIUM QUALITY INDICATOR

CALCULATION NUMBER 1

If any one of the items on the Current Assessment was scored:

Behaviour present, over last 7 days appears different from resident’s usual functioning (e.g. new onset or worsening)IF ( B5A_EASILY_DISTRACTED = new onset or worsening 2 OR B5B_PERIODS_OF_ALT_PERCEPT = new onset or worsening 2 OR B5C_EPISODES_OF_DISORG_SPEECH = new onset or worsening 2OR B5D_PERIODS_OF_RESTLESSNESS = new onset or worsening 2OR B5E_PERIODS_OF_LETHARGY = new onset or worsening 2OR B5F_MENTAL_FUNCTION_VARIES = new onset or worsening 2)

CALCULATION NUMBER 2

On the current assessment Behaviour present, not of recent onset AND

On the prior assessment Behaviour present, over last 7 days appears different from resident’s usual functioning (e.g. new onset or worsening)

( Recent B5A_EASILY_DISTRACTED = 1 AND PRIOR_B5a = 2OR Recent B5B_PERIODS_OF_ALT_PERCEPT = 1 AND PRIOR_B5b = 2 OR Recent B5C_EPISODES_OF_DISORG_SPEECH = 1 AND PRIOR_B5c = 2OR Recent B5D_PERIODS_OF_RESTLESSNESS = 1 AND PRIOR_B5d = 2OR Recent B5E_PERIODS_OF_LETHARGY = 1 AND PRIOR_B5e = 2OR Recent B5F_MENTAL_FUNCTION_VARIES = 1 AND PRIOR_B5f = 2)

CALCULATION NUMBER 3NOTE: In the 3rd potential trigger the Cognitive Performance Score (CPS) becomes part of the calculation. The CPS score for the resident must indicate that the resident is no more than moderately impaired (i.e. a score of 3 or less on the CPS).

On the current assessment Behaviour present, not of recent onset AND

On the prior assessment Behaviour not presentAND

On the current CPS A score of 3 or less(( Recent B5A_EASILY_DISTRACTED = 1 AND PRIOR_B5a = 0OR Recent B5B_PERIODS_OF_ALT_PERCEPT = 1 AND PRIOR_B5b = 0 OR Recent B5C_EPISODES_OF_DISORG_SPEECH = 1 AND PRIOR_B5c = 0OR Recent B5D_PERIODS_OF_RESTLESSNESS = 1 AND PRIOR_B5d = 0OR Recent B5E_PERIODS_OF_LETHARGY = 1 AND PRIOR_B5e = 0OR Recent B5F_MENTAL_FUNCTION_VARIES = 1 AND PRIOR_B5f = 0

))AND_CPS_cc_in_(0,1,2,3) 0 = Intact 1 = Borderline intact 2 = Mild impairment 3 = Moderate impairment

CALCULATION SUMMARY

Current

Not Present 0 Not Recent 1

Recent or Worse 2

Not Present 0 No Yes CPS 0,1,2,3 Yes

Prior Not Recent 1 No No YesRecent or Worse 2 No Yes Yes

SOURCE: interRAI, CIHI - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016

RAP

CAP

ReferencesinterRAI, Canadian Institute for Health Information - Continuing Care Reporting System RAI-MDS 2.0 Output Specifications, 2015–2016 http://cihi.ca

Canadian Institute for Health Information, HCC Medication List, 2015–2016 (For Use With CCRS and HCRS), Http://cihi.ca

Canadian Institute for Health Information, Your Health System, http://yourhealthsystem.cihi.ca/

Canadian Institute for Health Information, Resident Assessment Instrument (RAI) RAI-MDS 2.0 User’s Manual, Canadian Version, February 2012, Http://cihi.ca

Health Quality Ontario, http://www.hqontario.ca/public-reporting/long-term-care

Alberta Health, RAI-MDS 2.0 Quality Indicator Interpretation Guide, May 2015, http://www.health.alberta.ca/documents/CC-CIHI-RAI-Guide-2015.pdf

Canadian Institute for Health Information, CCRS Quality Indicators Risk Adjustment Methodology, 2013, https://www.cihi.ca/en/ccrs_qi_risk_adj_meth_2013_en.pdf.

interRAI, Http://interRAI.org