A research paper for the aged care royal commission is calling for the immediate establishment of around 10 additional quality indicators and an independent regulatory body to oversee transparent and routine monitoring and reporting of quality outcomes.

The South Australian Health and Medical Research Institute (SAHMRI) research released this week examines practices in 11 countries and 305 care quality indicators.

It shows a large range of quality outcome indicators can be produced from existing Australian data without any burden to aged care providers.

This would bring Australia closer leading quality reporting countries like Denmark, Sweden, Germany, the Netherlands, and the USA, compared to the current situation of three indicators for residential care and no care quality outcome reporting for home care.

The indicators SAHMRI found that could be added immediately include medication-related quality of care, falls and fractures, hospital re-admissions, hospitalisation for dementia or delirium, pain, premature mortality, pressure injury, utilisation of care plans and medication reviews, and weight loss or malnutrition.

Having these embedded as part of overall routine monitoring of aged care would be optimal for Australia, said paper author Associate Professor Gillian Caugheya principal research fellow at SAHMRI’s Registry of Senior Australians (ROSA).

Associate Professor Gillian Caughey

“It is imperative that Australia establish increased monitoring of aged care quality and safety indicators using currently available data to include a range of indicators that places no extra burden to aged care providers,” Associate Professor Caughey told Australian Ageing Agenda.

“An independent regulatory body that oversees the monitoring of quality and safety for both home care and residential aged care [should] be established to improve transparency and accountability of the system.  

“Quality of life data collection needs to also be embedded within data collection in aged care and included within the outcome monitoring system,” she said.

SAHMRI has suggested the independent regulatory body oversees the monitoring of quality indicators, including data custodianship, management and high quality reporting, which includes risk adjustment and reporting of benchmarking, to monitor facilities’ and providers’ quality and safety of care as another potential strategy to improve transparency and accountability in the system.

Australia compares variably internationally

The researchers also compared Australia’s performance with New Zealand, the USA, Canada, the United Kingdom, the Netherlands, Germany, Denmark, Finland, Sweden, and Iceland on various indicators.

Associate Professor Caughey said where comparable, Australia’s performance was varied in terms of quality and safety of care provided for residential aged care.

“For indicators where comparisons could be made, for example, the use of antipsychotic medications apart from incident use in short-stay residents was comparable between Australia, Canada and the USA, but performance was mixed compared to countries such as Finland, Iceland or Sweden,” she said.

Elsewhere the researchers found the rate of significant unplanned weight loss in Australia was on the lower end of performance compared to Canada, the USA and New Zealand. And the utilisation of medication reviews was considerably lower in Australia than Sweden.

Australia also showed mixed performance for pressure injuries but higher end of performance for re-hospitalisations and emergency department presentations within 30 days of discharge.

Royal Commissioners Tony Pagone and Lynelle Briggs

The royal commissioners Tony Pagone and Lynelle Briggs said the unbiased measurement and reporting of performance was vital to create accountability and continuous improvement in the aged care sector.

“Without it, problems are hidden from sight and not addressed,” the Commissioners said.

“It is unacceptable that in 2020 the aged care system is still without this. Had the Australian Government acted upon previous reviews of aged care, the persistent problems in aged care would have been known much earlier and the suffering of many people could have been avoided.”

To find out more on the paper’s findings and recommendations for aged care in the home, see Community Care Review’s report: Home care reporting lags on international scale

Access Research Paper 8 – International and National Quality and Safety Indicators for Aged Care here.

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