TY - JOUR
T1 - The quality of care delivered to residents in long-term care in Australia
T2 - an indicator-based review of resident records (CareTrack Aged study)
AU - Hibbert, Peter D.
AU - Molloy, Charlotte J.
AU - Cameron, Ian D.
AU - Gray, Leonard C.
AU - Reed, Richard L.
AU - Wiles, Louise K.
AU - Westbrook, Johanna
AU - Arnolda, Gaston
AU - Bilton, Rebecca
AU - Ash, Ruby
AU - Georgiou, Andrew
AU - Kitson, Alison
AU - Hughes, Clifford F.
AU - Gordon, Susan J.
AU - Mitchell, Rebecca J.
AU - Rapport, Frances
AU - Estabrooks, Carole
AU - Alexander, Gregory L.
AU - Vincent, Charles
AU - Edwards, Adrian
AU - Carson-Stevens, Andrew
AU - Wagner, Cordula
AU - McCormack, Brendan
AU - Braithwaite, Jeffrey
PY - 2024/1/23
Y1 - 2024/1/23
N2 - 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.
AB - 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.
KW - Aged care
KW - Clinical audit
KW - Evidence-based care
KW - Guideline adherence
KW - Healthcare evidence-based management
KW - Healthcare quality indicators
KW - Long-term care
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=85182851137&partnerID=8YFLogxK
U2 - 10.1186/s12916-023-03224-8
DO - 10.1186/s12916-023-03224-8
M3 - Article
C2 - 38254113
AN - SCOPUS:85182851137
SN - 1741-7015
VL - 22
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 22
ER -
