Pan-Canadian quality indicators for patients at end of life derived from interRAI data

Rationale Currently in Canada, there are no standardized quality indicators (QIs) for end-of-life home care services. InterRAI assessment data are available in multiple provinces and contain patient-level symptom and performance status data for seriously-ill patients using home care services. Objective To report on novel QIs using interRAI data for seriously-ill cancer and non-cancer patients across Canada. Methods We undertook a cross sectional analysis of the Resident Assessment Instrument for Home Care (RAI-HC) data from 2006-2016 for five provinces (Alberta, British Columbia, Nova Scotia, Ontario, and Manitoba). Those eligible to be included in the QI rates had to have a prognosis of six months or less, a score of 4+ on the CHESS scale, or be assessed as palliative on admission into home care. 11 QI indicators were developed: prevalence of fall, caregiver distress, loneliness, inadequate pain control, constipation, negative mood, daily pain, delirium, any pressure ulcer, an ED visit, or hospital admission. We examined cancer and non-cancer separately. Results Among 2,697,567 interRAI assessments across 5 provinces, 12,479 (cancer) and 26,877 (non-cancer) individuals were identified as seriously-ill and included in the cohort. The non-cancer cohort was older, more female, with more comorbidities than cancer cohort. Across Canada, QIs with the highest overall prevalence for cancer vs. non-cancer were daily pain (48% v. 43%), any hospital admission (46% v. 44%), and falls (40% v. 53%). Prevalence of caregiver distress (31% v. 43%), delirium (17% v. 26%), and inadequate pain control (21% v. 21%) were reported nationally. We also looked at the QI rates by province, which varied considerably. Conclusions This study advances the development of QIs for seriously-ill patients. It uses standardized and nationally-collected data via interRAI assessments to compare national and provincial QI rates. These QIs can act as decision-support tools to monitor quality over time and improve care for individuals at the end of life.