Quality and safety in residential aged care: an evaluation of a national quality indicator programme

Maria C Inacio; Tesfahun C Eshetie; Gillian E Caughey; Craig Whitehead; Johanna Westbrook; Len Gray; Peter Hibbert; Elizabeth Beattie; Jeffrey Braithwaite; Ian D Cameron; Maria Crotty; Steve Wesselingh

doi:10.1111/imj.16052

Quality and safety in residential aged care: an evaluation of a national quality indicator programme

Intern Med J. 2023 Nov;53(11):2073-2078. doi: 10.1111/imj.16052. Epub 2023 Mar 22.

Authors

Maria C Inacio^{1

2}, Tesfahun C Eshetie^{1

3}, Gillian E Caughey^{1

2

4}, Craig Whitehead^{5

6}, Johanna Westbrook⁷, Len Gray⁸, Peter Hibbert⁹, Elizabeth Beattie¹⁰, Jeffrey Braithwaite⁹, Ian D Cameron¹¹, Maria Crotty^{5

6}, Steve Wesselingh¹

Affiliations

¹ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
² UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
³ UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
⁴ Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
⁵ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁶ Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
⁷ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁸ Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.
⁹ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
¹⁰ School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
¹¹ John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Background: In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities.

Aim: To examine the validity of the QI programme indicators using explicit measure review criteria.

Methods: The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine-point scale. A median score of 1-3 was considered to not meet criteria, 4-6 to meet some criteria and 7-9 to meet criteria.

Results: All indicators, except polypharmacy, met criteria (median scores = 7-9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2-8), appropriateness (median = 5, range 2-8) and clinical evidence (median = 6, range 3-8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6-7, range 4-8) and met criteria for feasibility and applicability (median = 7, range 4-8).

Conclusions: Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.

Keywords: nursing homes; quality improvement; quality indicators; quality measurement; residential aged care.

MeSH terms

Aged
Australia
Homes for the Aged*
Humans
Polypharmacy
Quality Indicators, Health Care*
Weight Loss

Abstract

MeSH terms

Grants and funding