ROSA develops home care QI system using existing data

The Registry of Senior Australians has developed a comprehensive outcome monitoring system using available data that the government could use to monitor home aged care services without placing additional burden on providers.

The ROSA research project published in BMJ Open this month developed 15 quality and safety indicators using existing data and measures such as medication and hospitalisation outcomes and the receipt of a chronic disease management plan.

Lead researcher Professor Gillian Caughey said this outcome monitoring system could fill a gap in routine monitoring of home care quality, which was essential to ensuring the provision of appropriate and high-quality services.

“Ideally this outcome monitoring system can be used by aged care providers but importantly the Federal Government could use this to monitor quality and safety of home care services using existing data that is available, without placing additional burden on aged care providers; leaving them to focus on care delivery rather than additional data collection,” Professor Caughey told Australian Ageing Agenda.

The Australian Government has pledged to introduce quality indicators for home care, but the planned trial to identify, assess and pilot evidence-based quality indicators in up to five areas has been postponed to support greater alignment with the new Support at Home Program.

Unlike ROSA’s system, the government’s proposed program will require additional data collection by aged care providers, said Professor Caughey, associate director of ROSA, which is based at South Australian Health and Medical Research Institute.

“These indicators in our comprehensive outcome monitoring system use existing data that is routinely collected to provide a comprehensive overview of quality and safety measures of care access, outcomes and variation in care. Also our indicators are risk adjusted, which means we can make meaningful comparisons when examining variation in care and benchmarking.”

Study investigates prevalence of indicators

The monitoring system includes 12 outcome indicators related to medication (four), hospitalisation (seven) and premature death (one) plus three process indicators – such as a chronic disease management plan, home medicines review and wait time to receive a home care package.

In addition to developing the indicators, ROSA’s study examined their prevalence among 90,650 home care package recipients throughout 2016. It found a high prevalence of the medication-related indicators and identified a potential red flag among people on higher care packages, who had a lower uptake of chronic disease management plans and medicines reviews despite their higher care needs.

“Over half of home care recipients received an antibiotic within a 12-month period, almost a third had a high sedative load – which is based on the use of multiple medicines that have a sedating effect and places individuals at increased risk of medicine-related harms – and one in 10 had chronic opioid use.

“As expected, the prevalence of these medication-related quality indicators was higher in individuals receiving a level 3 or 4 home care package compared to a level 1 or 2. But potentially of concern is that use of chronic disease management plans and home medicines reviews were lower in those receiving level 3 or 4 packages despite potentially having more complex care needs and may likely benefit from these types of care services,” Professor Caughey said.

Elsewhere the study found a quarter of home care recipients were hospitalised again within 30 days of being discharged from hospital (25 per cent) and one in 10 were hospitalised for a fall. Of the people with dementia, 10 per cent were hospitalised for their dementia or delirium.

“Some of the medicines that we examined that had a high prevalence, are known to be associated with increased risk of hospitalisations, falls and delirium, highlighting areas for quality improvement,” Professor Caughey said.

System supports evidence-based quality and safety improvement

Professor Caughey said understanding where care was done well or not so well provided an opportunity for targeted quality improvement programs or strategies to improve health outcomes and wellbeing. It also provides valuable insights into variation and quality of care, she said.

“As the old saying goes – ‘if you can’t measure it, you can’t improve it’ and, importantly, this [outcome monitoring system] provides evidence, insight and an opportunity to improve care and wellbeing for Australia’s aged care population.”

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