InterRAI home care quality indicators

John N Morris,Dinnus Frijters,R Knight Steel,John P Hirdes,Brant E Fries

doi:10.1186/1471-2318-13-127

Abstract

BackgroundThis paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI’s widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced.MethodsTwo data sets were used: at the client and home-care site levels. Client-level data were employed to identify HC-QI covariates. This sample consisted of 335,544 clients from Europe, Canada, and the United States. Program level analyses, where client level data were aggregated at the site level, were also based on the clients from the samples from Europe, Canada, and the United States. There were 1,654 program-based observations – 22% from Europe, 23% from the US, and 55% from Canada.The first task was to identify potential HC-QIs, including both change and prevalence measures. Next, they were reviewed by industry representatives and members of the interRAI network. A two-step process adjustment was followed to identify the most appropriate covariance structure for each HC-QI. Finally, a factor analytic strategy was used to identify HC-QIs that cluster together and thus are candidates for summary scales.ResultsThe set of risk adjusted HC-QIs are multi-dimensional in scope, including measures of function, clinical complexity, social life, distress, and service use. Two factors were identified. The first includes a set of eleven measures that revolve around the absence of decline. This scale talks about functional independence and engagement. The second factor, anchored on nine functional improvement HC-QIs, referenced positively, this scale indicates a return to clinical balance.ConclusionsTwenty-three risk-adjusted, HC-QIs are described. Two new summary HC-QI scales, the “Independence Quality Scale” and the “Clinical Balance Quality Scale” are derived. In use at a site, these two scales can provide a macro view of local performance, offering a way for a home care agency to understand its performance. When scales perform less positively, the site then is able to review the HC-QI items that make up the scale, providing a roadmap for areas of greatest concern and in need of targeted interventions.

Highlights

This paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs)
This paper describes interRAI’s second-generation home care quality indicators (HC-QIs), refining and updating measures that have been in use in several countries over the prior decade
In the current second-generation measures, each Home Care Assessment (HC)-QI was reviewed against a broad array of baseline measures of cognition, physical function, clinical complications, and age, with each model including items that reference the time between assessments

Summary

Introduction

This paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). This paper describes interRAI’s second-generation home care quality indicators (HC-QIs), refining and updating measures that have been in use in several countries over the prior decade They are derived from two widely used assessments of community-dwelling persons, the interRAI Community Health Assessment (CHA) and the interRAI Home Care Assessment (HC) [1,2,3,4]. With the availability of a significantly larger cross-national dataset, the covariate structure that risk-adjusts the indicators were updated and a new, more powerful, two-step adjustment model introduced [8] These latter improvements are critical, as the crosssite variation in a raw quality indicator value is difficult to interpret as they tangle variations in the functionality or other characteristics of the persons served with the nature of the services offered. Once these adjustors have been applied, it is reasonable to presume that significant cross-program differences in HCQI scores are based on service diversity

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Discussion

Conclusion