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
Affiliations
Peter D. Hibbert
Australian Institute of Health Innovation, Macquarie University
Charlotte J. Molloy
Australian Institute of Health Innovation, Macquarie University
Ian D. Cameron
John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Faculty of Medicine and Health, University of Sydney, Kolling Institute
Leonard C. Gray
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital Campus
Richard L. Reed
Discipline of General Practice, College of Medicine and Public Health, Flinders University
Louise K. Wiles
Australian Institute of Health Innovation, Macquarie University
Johanna Westbrook
Australian Institute of Health Innovation, Macquarie University
Gaston Arnolda
Australian Institute of Health Innovation, Macquarie University
Rebecca Bilton
Australian Institute of Health Innovation, Macquarie University
Ruby Ash
Australian Institute of Health Innovation, Macquarie University
Andrew Georgiou
Australian Institute of Health Innovation, Macquarie University
Alison Kitson
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University
Clifford F. Hughes
Australian Institute of Health Innovation, Macquarie University
Susan J. Gordon
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University
Rebecca J. Mitchell
Australian Institute of Health Innovation, Macquarie University
Frances Rapport
Australian Institute of Health Innovation, Macquarie University
Carole Estabrooks
Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy
Gregory L. Alexander
Columbia University School of Nursing
Charles Vincent
Department of Experimental Psychology, Radcliffe Observatory, University of Oxford
Adrian Edwards
PRIME Centre Wales & Division of Population Medicine, Cardiff University
Andrew Carson-Stevens
PRIME Centre Wales & Division of Population Medicine, Cardiff University
Cordula Wagner
Netherlands Institute for Health Services Research
Brendan McCormack
The Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney
Jeffrey Braithwaite
Australian Institute of Health Innovation, Macquarie University
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.
