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)

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

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

64 Downloads (Pure)

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.

Original language	English
Article number	22
Number of pages	15
Journal	BMC Medicine
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12916-023-03224-8
Publication status	Published - 23 Jan 2024

Keywords

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

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10.1186/s12916-023-03224-8Licence: CC BY

Final published versionFinal published version, 1.31 MBLicence: CC BY

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Hibbert, P. D., Molloy, C. J., Cameron, I. D., Gray, L. C., Reed, R. L., Wiles, L. K., Westbrook, J., Arnolda, G., Bilton, R., Ash, R., Georgiou, A., Kitson, A., Hughes, C. F., Gordon, S. J., Mitchell, R. J., Rapport, F., Estabrooks, C., Alexander, G. L., Vincent, C., ... Braithwaite, J. (2024). The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study). BMC Medicine, 22(1), Article 22. https://doi.org/10.1186/s12916-023-03224-8

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

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",

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

year = "2024",

month = jan,

day = "23",

doi = "10.1186/s12916-023-03224-8",

language = "English",

volume = "22",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

Hibbert, PD, Molloy, CJ, Cameron, ID, Gray, LC, Reed, RL, Wiles, LK, Westbrook, J, Arnolda, G, Bilton, R, Ash, R, Georgiou, A, Kitson, A, Hughes, CF, Gordon, SJ, Mitchell, RJ, Rapport, F, Estabrooks, C, Alexander, GL, Vincent, C, Edwards, A, Carson-Stevens, A, Wagner, C, McCormack, B & Braithwaite, J 2024, 'The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study)', BMC Medicine, vol. 22, no. 1, 22. https://doi.org/10.1186/s12916-023-03224-8

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 - https://www.scopus.com/pages/publications/85182851137

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 -

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

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