New group launches to improve aged care quality

A national research collaboration launched this week has produced comprehensive sets of over 200 quality indicators it says can offer immediate action on reforms proposed in the royal commission’s final report.

The Australian Consortium for Aged Care, which launched on Tuesday, is a joint initiative of the Australian Institute of Health Innovation (AIHI) at Macquarie University, the Registry of Senior Australians (ROSA) at the South Australian Health and Medical Research Institute, the Centre for Health Services Research at the University of Queensland, and the Queensland University of Technology.

ACAC aims to answer key research questions that underpin, inform and monitor the policy response and implementation of the recommendations of the Royal Commission into Aged Care Quality and Safety.

In their report released on Monday, the aged care royal commissioners found the difficulty in measuring quality in the current aged care system “a major failing” and the lack of quality indicator data “a significant impediment” to understanding the performance of the system and providers, and ensuring accountability for that performance.

Under the National Aged Care Mandatory Quality Indicator Program, which became compulsory in 2019, residential aged care services must report on three indicators: pressure injuries, use of physical restraint and unplanned weight loss. They must additionally report on falls and major injury and medication management from July this year.

Consortium member Associate Professor Peter Hibbert from AIHI said the group has 235 evidence-based process and outcome indicators that are action based and measure quality at the resident level.

“They include indicators like whether a resident receives a monthly assessment of malnutrition based on a validated tool. That is a nice one from the royal commission,” Associate Professor Hibbert told Australian Ageing Agenda.

The indicators come from ROSA’s process and outcomes collection already in use, which pull from electronic aged care records, the Centre for Health Services Research’s interRAI, which involves a collaboration of 35 countries and mostly outcomes indicators, and AIHI’s CareTrack Aged process indicators.

He said the sets cover 15 key areas – many of which have been quoted in the royal commission –including cognitive impairment, nutrition, falls prevention and mobility, pain, oral care, medication management, pressure ulcers, wound management, continence care, palliative care and physical strength.

He said the quality indicators differ to accreditation standards, which are often about setting up a system.

“The standard might be around ‘ensure you’ve got a system that picks up malnutrition in a timely way,’ but it doesn’t say measure it at a resident level whilst our process indicators measure at a resident level.”

Other quality indicators in ACACs sets include “a resident should be prescribed a strength and balancing exercise training program to prevent falls” and “residents with oral disease should be referred to a dentist,” Associate Professor Hibbert said.

“They are very action based, specific and designed to be clear.”

Another example is, how many residents suffer a fracture from a fall in a 12-month period?

RC recommends expansion of indicators, benchmarking

In their final report, the royal commissioners recommend the introduciton of a more comprehensive suite of quality indicators for both residential and home aged care, including a quality of life assessment tool, from July 2023.

They also call for the benchmarking and reporting of provider performance against quality indicators including via the proposed star rating tool from July 2022.

The benchmarks should be used to track sector and provider performance and set progressive improvement targets to raise performance over time, the commissioners wrote.

Associate Professor Hibbert said he supported the recommendations and that ACAC could help with achieving them.

These quality indicators can also be used to benchmark provider and system performance that the royal commissioner has recommended government establish a system for, he said.

While consumers can use benchmarking data to make decisions about their care, it is a motivator for providers to improve their standing, he said.

“The research from healthcare is that publicly facing indicators seem to have a greater impact on provider behaviour than consumer behaviour,” Associate Professor Hibbert said.

“Having a more comprehensive set of indicators and having them transparent enables more accountability and responsibility from the providers.”

They also need to be presented in a consumer friendly way to enable consumers to use them, he said.

Associate Professor Hibbert said the consortium is targeting governments and policy makers to implement these indicators, such as through a large audit approach.

Some of the more detailed indicators could also be used at the aged care home level, for a facility that wants to do an improvement program such as on nutrition or pain management, he said.

“They’ll do like a deep dive using those indicators at facility level and then do an improvement program on that. And then they’ll move on to the next thing.”

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