Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces.

Abstract

<b><i>Background:</i></b> Few measures exist to assess the quality of care received by home care clients, especially at the end of life. <b><i>Objective:</i></b> This project examined the rates across a set of quality indicators (QIs) for seriously ill home care clients. <b><i>Design:</i></b> This was a cross-sectional descriptive analysis of secondary data collected using a standardized assessment tool, the Resident Assessment Instrument for Home Care (RAI-HC). <b><i>Setting/Subjects:</i></b> The sample included RAI-HC data for 66,787 unique clients collected between January 2006 and March 2018 in six provinces. Individuals were defined as being seriously ill if they experienced a high level of health instability, had a prognosis of less than six months, and/or had palliative care as a goal of care. <b><i>Measurements:</i></b> We compared individuals with cancer (<i>n</i> = 21,119) with those without cancer (<i>n</i> = 47,668) on demographic characteristics, health-related outcomes, and on 11 QIs. <b><i>Results:</i></b> Regardless of diagnosis, home care clients experienced high rates (i.e., poor performance) on several QIs, namely the prevalence of falls (cancer = 42.4%; noncancer = 55%), daily pain (cancer = 48.3%; noncancer = 43.2%), and hospital admissions (cancer = 48%; noncancer = 46.6%). The QI rates were significantly lower (i.e., better performance) for the cancer group for three out of the 11 QIs: falls (absolute standardized difference [SD] = 0.25), caregiver distress (SD = 0.28), and delirium (SD = 0.23). <b><i>Conclusions:</i></b> On several potential QIs, seriously ill home care clients experience high rates, pointing to potential areas for quality improvement across Canada.