The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

Peter D Hibbert; Charlotte J Molloy; Ian D Cameron; Leonard C Gray; Richard L Reed; Louise K Wiles; Johanna Westbrook; Gaston Arnolda; Rebecca Bilton; Ruby Ash; Andrew Georgiou; Alison Kitson; Clifford F Hughes; Susan J Gordon; Rebecca J Mitchell; Frances Rapport; Carole Estabrooks; Gregory L Alexander; Charles Vincent; Adrian Edwards; Andrew Carson-Stevens; Cordula Wagner; Brendan McCormack; Jeffrey Braithwaite

doi:10.1186/s12916-023-03224-8

The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)

BMC Med. 2024 Jan 23;22(1):22. doi: 10.1186/s12916-023-03224-8.

Authors

Peter D Hibbert^{1

2

3}, Charlotte J Molloy^{4

5

6}, Ian D Cameron⁷, Leonard C Gray⁸, Richard L Reed⁹, Louise K Wiles^{4

5}, Johanna Westbrook⁴, Gaston Arnolda⁴, Rebecca Bilton^{4

10}, Ruby Ash⁴, Andrew Georgiou⁴, Alison Kitson¹⁰, Clifford F Hughes⁴, Susan J Gordon¹⁰, Rebecca J Mitchell⁴, Frances Rapport⁴, Carole Estabrooks¹¹, Gregory L Alexander¹², Charles Vincent¹³, Adrian Edwards¹⁴, Andrew Carson-Stevens¹⁴, Cordula Wagner^{15

16}, Brendan McCormack¹⁷, Jeffrey Braithwaite⁴

Affiliations

¹ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia. peter.hibbert@mq.edu.au.
² IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia. peter.hibbert@mq.edu.au.
³ South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia. peter.hibbert@mq.edu.au.
⁴ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia.
⁵ IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
⁶ South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
⁷ John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Faculty of Medicine and Health, University of Sydney, Kolling Institute, Reserve Rd, St Leonards, NSW, 2065, Australia.
⁸ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, QLD, 4102, Australia.
⁹ Discipline of General Practice, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia.
¹⁰ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia.
¹¹ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
¹² Columbia University School of Nursing, 560 W. 168Th, New York, NY, USA.
¹³ Department of Experimental Psychology, Radcliffe Observatory, University of Oxford, Woodstock Road, Oxford, OX2 6GG, England, UK.
¹⁴ PRIME Centre Wales & Division of Population Medicine, Cardiff University, 8Th Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK.
¹⁵ Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513 CR, The Netherlands.
¹⁶ Amsterdam University Medical Center/VU University, Van Der Boechorststraat 7, 1081 HV, Amsterdam, The Netherlands.
¹⁷ The Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, City Road, Sydney, NSW, 2006, Australia.

Abstract

Background: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations.

Methods: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators.

Results: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators.

Conclusions: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

Keywords: Aged care; Clinical audit; Evidence-based care; Guideline adherence; Healthcare evidence-based management; Healthcare quality indicators; Long-term care; Quality of care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia / epidemiology
Health Facilities
Humans
Long-Term Care*
Quality of Health Care
Terminal Care*

Grants and funding

1143223/National Health and Medical Research Council