Clinical Quality Indicators for Monitoring Hospitalizations Among Older People with Dementia Accessing Aged Care Services

Article type: Research Article

Authors: Sluggett, Janet K.^{a; b; *} | Air, Tracy^b | Cations, Monica^{b; c} | Caughey, Gillian E.^{a; b} | Lang, Catherine E.^b | Ward, Stephanie A.^{d; e; f} | Ahern, Susannah^f | Lin, Xiaoping^f | Wallis, Kasey^f | Crotty, Maria^{g; h} | Inacio, Maria C.^{a; b}

Affiliations: [a] University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia | [b] Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia | [c] College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia | [d] Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia | [e] Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia | [f] School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia | [g] Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia | [h] College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Correspondence: [*] Correspondence to: Janet K. Sluggett, PhD, Enterprise Fellow, University of South Australia, UniSA Allied Health and Human Performance, GPO Box 2471, Adelaide, South Australia, Australia. Tel.: +61 8 8128 4055; E-mail: janet.sluggett@unisa.edu.au.

Abstract: Background:There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer’s disease and other forms of dementia. Objective:To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia accessing aged care services and determine 1) annual trends in CQI incidence between 2011–2012 and 2015–2016, 2) associated factors, and 3) geographic and facility variation in CQI incidence. Methods:This retrospective repeated cross-sectional study included non-Indigenous individuals aged 65–105 years who lived with dementia between July 2008-June 2016, were assessed for government-funded aged care services, and resided in New South Wales or Victoria (n = 180,675). Poisson or negative binomial regression models estimated trends in annual CQI incidence and associated factors. Funnel plots examined CQI variation. Results:Between 2011–2012 and 2015–2016, CQI incidence increased for falls (11.0% to 13.9%, adjusted incidence rate ratio (aIRR) 1.05 (95% CI 1.01–1.06)) and delirium (4.7% to 6.7%, aIRR 1.09 (95% CI 1.07–1.10)), decreased for unplanned hospitalizations (28.7% to 27.9%, aIRR 0.99 (95% CI 0.98–0.99)) and remained steady for fracture (6.2% to 6.5%, aIRR 1.01 (95% CI 0.99–1.01)) and pressure injuries (0.5% to 0.4%, aIRR 0.99 (95% CI 0.96–1.02)). Being male, older, having more comorbidities and living in a major city were associated with higher CQI incidence. Considerable geographical and facility variation was observed for unplanned hospitalizations and delirium CQIs. Conclusions:The CQI results highlighted considerable morbidity. The CQIs tested should be considered for application in clinical quality registries to monitor dementia care quality.

Keywords: Accidental falls, Alzheimer’s disease, bone fractures, delirium, dementia, home care services, hospitalization, long-term care, nursing homes, pressure ulcer

DOI: 10.3233/JAD-230730

Journal: Journal of Alzheimer's Disease, vol. 96, no. 4, pp. 1747-1758, 2023