The first-of-its-kind study investigating how much evidence-based care is being delivered to aged care residents has published a new paper outlining the indicators and processes developed to determine the result. Nurse surveyors are about two-thirds of the way through the representative review of the care Australian aged care residents are receiving.

As previously reported, the five-year NHMRC funded project – CareTrack Aged – aims to measure the level of evidence-based care that’s being delivered to residents in aged care at the population level. It follows two big hospital-based studies asking a similar question about care for adults and children.

Those studies returned an answer of around 60 per cent in each, said CareTrack Aged program manager Associate Professor Peter Hibbert from Macquarie University’s Australian Institute of Health Innovation.

Associate Professor Peter Hibbert

“Before you can do a study on the level of evidence-based care delivered to aged care residents, you firstly need to understand what evidence-based care is,” Associate Professor Hibbert told Australian Ageing Agenda. “And that’s what this recent paper is about.”

The team of researchers from five universities in four states completed a systematic review and analysis of 139 clinical practice guidelines from around the world and their 5,609 recommendations. The result is 236 indicators across 16 conditions and processes, which have been recently published in the International Journal For Quality in Health Care.

The conditions and processes are admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life or palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep.

“We’ve developed these 236 indicators and now [employed nurse surveyors are] going out to about 45 facilities, and they are reviewing about 350 residents’ records against the indicators,” Associate Professor Hibbert said. “And the answer being: Was care in line with what the indicator said? Or was it not?”

The surveyors have completed the reviews at about 30 facilities to date. COVID-19 has delayed the study and confined it to facilities in two states – Victoria and South Australia – rather than the four it had planned for.

“This will be the world’s first study at a population level of whether residents receive evidence-based care in aged care.”

Associate Professor Hibbert said it was important to delineate the indicators developed for the study from the National Aged Care Mandatory Quality Indicator Program, which currently has five national indicators – pressure injuries, physical restraint, unplanned weight loss, falls and major injury, and medication.

The national program uses outcomes indicators such as “what’s the prevalence of all residents who have weight loss?” where “our indicators are process indicators; so they take you through a set of steps that should be done that are based on the evidence,” he said.

“An example of nutrition and hydration as an outcome indicator is the percentage of residents who are suffering malnourishment. One of our process indicators is residents should receive monthly screening for malnutrition using a validated tool.”

There are 20 nutrition and hydration process indicators in the set with another being that residents who have unplanned weight loss or who are at risk of weight loss should receive a referral to a general practitioner and a dietitian.

“Our surveyors are looking if that happens. For each resident, they go in and say, ‘Can we see a monthly screening for malnutrition? And was there a validated tool?’ And then if they if they see that anyone’s got unplanned weight loss, they look for referrals to GPs and dietitians and then they score that as a yes or no,” Associate Professor Hibbert said.

The advantage of outcome indicators is they are what facilities are trying to achieve while the advantage of process indicators is they’re actions that facilities can be in control of, Associate Professor Hibbert said. For this reason the researchers envisage the process indicators being used periodically for quality improvement purposes for organisations or facilities..

“We know that 236 indicators is not viable to be used on a standardised basis at a local level, but because they’re broken up into conditions, if a facility is interested in a collaborative or quality improvement project in a particular area – such as nutrition and hydration – then they can use the indicators to measure how they’re going in that area. And then use it to kick off an improvement process.”

Associate Professor Hibbert would not comment on early findings or suspected outcomes of the study, but said they expected to publish CareTrack Aged results in the second quarter of next year.

“This will be the world’s first study at a population level of whether residents receive evidence-based care in aged care,” he said.

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