A Comparison of Home care Quality Indicators and The Influence of Risk Adjustment Between Two provinces

Introduction: Currently, there is a lack of research examining the demographic characteristics, levels of impairment and the quality of care being delivered to home care clients in Canada. Methods: The data for this project were collected using the Resident Assessment Instrument for Home Care (RAI-HC), a multidimensional tool used to assess clients' needs. Home care quality indicators (HCQIs) generated from items within the RAI-HC were expressed as rates of negative outcomes. Risk adjustment of the rates was used to enable fair regional comparisons by controlling for client characteristics that may increase the HCQI rates irrespective of the quality of care. Home care providers completed assessments in a sample of 111,804 older (65+) clients from Ontario and Winnipeg. Both the unadjusted and adjusted rates were compared between these regions. A multivariate logistic regression model was constructed to understand the most important covariates to be used in risk adjustment for the incidence of cognitive decline HCQI. Other analyses examined both the convergent and divergent validity of this HCQI. Results: Clients had a mean age of 83.2 (s= 7.6), 69% were female and 76% of clients in Ontario, and 68% of clients in Winnipeg, experienced cognitive decline. A diagnosis of dementia, being at least 75 years of age and the presence of bowel incontinence were the most important predictors of the cognitive decline HCQI (p< 0.0001). Analysis also supported the convergent and divergent validity for the cognitive decline HCQI. Conclusions: A higher proportion of clients in Ontario experienced cognitive and functional impairment and as such, had higher overall HCQI rates. Risk adjustment decreased the provincial differences, and the original risk adjusters, developed by interRAI, were applicable to the current home care population for the cognitive decline HCQ1. Implications: The use of these HCQ1s, in conjunction with current quality assessment instruments, adds a dimension to continuous quality improvement based on client-level data. Additionally these indicators, derived from the MDS-HC and generated from the computer software, could allow cross-Canadian communication about quality. Improved communication between provinces could lead to sharing of successful best practice strategies between different agencies to improve client care.

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