Master of Science (MSc)
Faculty of Science
Dr. Dawn Guthrie
Introduction Currently in Ontario, there is no set of quality indicators for use in palliative care settings. Palliative care research tends to focus heavily on those with cancer diagnoses, and therefore potentially misses those with other life limiting illnesses. The current study aims to develop a preliminary set of quality indicators relevant for seriously-ill individuals for use in the community. Methods Secondary analysis of Resident Assessment Instrument for Home Care (RAI-HC) data from 2006-2013 (n=263,767) was used to develop QIs thought to be relevant to the needs of seriously-ill home care clients. Seriously-ill clients were defined as those with a prognosis of 6 months or less and a high level of health instability indicated by the CHESS scale. Consultations with subject matter experts (SMEs) took place to gain insight as to what was important to measure for seriously-ill individuals. Client-level risk adjustment was performed on the quality indicators (QIs) that the SMEs deemed appropriate. The QI rates were stratified across local health integration networks to examine regional variations across Ontario.
Results 14,312 home care clients were defined as seriously-ill. Among these clients, they were more likely to experience negative health factors such as greater impairment on health index scales, had higher proportions of life limiting illnesses, and were more likely to trigger most of the Clinical Assessment Protocols. A preliminary set of QIs was modified after the SME consultations were complete, a total of eight quality indicators were developed for use with the RAI-HC, two with client-level risk adjustment. QIs with the highest rates were prevalence of shortness of breath (66.2%), prevalence of falls (49.0%) and prevalence of daily pain (46.6%). The North West LHIN had higher rates than the Central LHIN for six out of eight of the QIs. Conclusion The current study was successful in identifying seriously-ill home care clients from RAI-HC data, which adds to the literature as it provides a new way to identify those who are seriously-ill beyond prognosis. This study also developed a list of preliminary quality indicators that provide a foundation for future research to work towards a final set for use in the community. Implications Quality indicators have the potential to contribute to continuous quality improvement by flagging potential quality issues of health care providers. Quality improvement allows for more effective care and reduced negative outcomes for seriously-ill clients and their families.
Harman, Lisa, "Developing and Testing Quality Indicators for Seriously-ill Home Care Clients in Ontario" (2017). Theses and Dissertations (Comprehensive). 1939.
Available for download on Wednesday, June 26, 2019