The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care

Abstract

OBJECTIVES:To introduce the Registry of Senior Australians (ROSA) Outcome Monitoring System, which can monitor the quality and safety of care provided to individuals accessing residential aged care. Development and examination of twelve quality and safety indicators of care and their 2016 prevalence estimates are presented. DESIGN:Retrospective. SETTING:2,690 national and 254 South Australian (SA) aged care facilities. PARTICIPANTS:208,355 unique residents nationally and 18,956 in SA. MAIN OUTCOME MEASURES:Risk adjusted prevalence of high sedative load, antipsychotic use, chronic opioid use, antibiotic use, premature mortality, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium and/or dementia hospitalisations, emergency department presentations, and pressure injuries. RESULTS:Five indicators were estimated nationally; antibiotic use (67.5%, 95% confidence interval (CI) 67.3-67.7%) had the highest prevalence, followed by high sedative load (48.1%, 95% CI 47.9-48.3%), chronic opioid use (26.8%, 95% CI 26.6-26.9%), antipsychotic use (23.5%, 95% CI 23.4-23.7%), and premature mortality (0.6%, 95% CI 0.6-0.7%). Seven indicators were estimated in SA; emergency department presentations (19.1%, 95% CI 18.3-20.0%) had the highest prevalence, followed by falls (10.1%, 95% CI 9.7-10.4%), fractures (4.8%, 95% CI 4.6-5.1%), pressure injuries (2.9%, 95% CI 2.7-3.1%), delirium and/or dementia related hospitalisations (2.3%, 95% CI 2.1-2.6%), weight loss/malnutrition (0.7%, 95% CI 0.6-0.8%), and medication-related events (0.6%, 95% CI 0.5-0.7%). CONCLUSIONS:Twelve quality and safety indicators were developed to monitor aged care provided to older Australians based on the synthesis of existing literature and expert advisory input. These indicators rely on existing data within the aged care and health care sectors, therefore creating a pragmatic tool to examine quality and unwarranted care variation.