Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care.
Objective:
To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances.
Methods:
Retrospective cohort study (2011–2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation.
Results:
CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02–1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10–1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12–1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03–1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0–92%).
Conclusion:
Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.
BrownL, HansnataE, LaHA (2017) Economic cost of dementia inAustralia 2016-2056. National Centre for Social and Economic Modelling & Alzheimer’s Australia, Canberra. https://www.fightdementia.org.au.
Guideline Adaptation Committee (2016) Clinical practice guidelines and principles of care for people with dementia. Guideline Adaptation Committee, Sydney, Australia.
Department of Health Australia (2017) Your guide to commonwealth home support programme. Department of Health, https://www.myagedcare.gov.au, Accessed May 20, 2018.
7.
Department of Health Australia (2012) Living longer. Living better. Australian Government, https://apo.org.au/node/29086, Accessed August 31, 2016.
CampbellSM, BraspenningJ, HutchinsonA, MarshallMN (2003) Research methods used in developing and applying quality indicators in primary care. BMJ326, 816–819.
11.
MainzJ (2003) Defining and classifying clinical indicators for quality improvement. ,. Int J Qual Health Care15, 523–530.
12.
InacioMC, LangC, CaugheyGE, BraySCE, HarrisonSL, WhiteheadC, VisvanathanR, EvansK, CorlisM, CornellV, WesselinghS (2020) The registry of senior australians outcome monitoring system: Quality and safety indicators for residential aged care. ,. Int J Qual Health Care32, 502–510.
13.
JensdottirAB, RantzM, HjaltadottirI, GudmundsdottirH, RookM, GrandoV (2003) International comparison of quality indicators in United States, Icelandic and Canadian nursing facilities. Int Nurs Rev50, 79–84.
OostraDL, NieuwboerMS, Olde RikkertMGM, PerryM (2020) Development and pilot testing of quality improvement indicators for integrated primary dementia care. BMJ Open Qual9, e000916.
16.
PerryM, DraskovićI, van AchterbergT, van EijkenM, LucassenP, Vernooij-DassenM, Olde RikkertM (2010) Development and validation of quality indicators for dementia diagnosis and management in a primary care setting. J Am Geriatr Soc58, 557–563.
17.
AytonD, GardamM, WardS, BrodatyH, PritchardE, EarnestA, KrysinskaK, Banaszak-HollJ, McNeilJ, AhernS (2020) How can quality of dementia care be measured? The development of clinical quality indicators for an australian pilot dementia registry. J Alzheimers Dis75, 923–936.
18.
LinX, WallisK, WardSA, BrodatyH, SachdevPS, NaismithSL, KrysinskaK, McNeilJ, RoweCC, AhernS (2020) The protocol of a clinical quality registry for dementia and mild cognitive impairment (MCI): The Australian dementia network (ADNeT) registry. BMC Geriatr20, 330.
InacioMC, BraySCE, WhiteheadC, CorlisM, VisvanathanR, EvansK, GriffithE, WesselinghS (2019) The Registry of Older South Australians (ROSA): Framework and plan. BMJ Open9, e02619.
22.
InacioMC, LangC, BraySCE, VisvanathanR, WhiteheadC, GriffithEC, EvansK, CorlisM, WesselinghS (2021) Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: The Registry of Senior Australians historical cohort. Intern Med J51, 712–724.
PrattN, KerrM, BarrattJ, Kemp-CaseyA, Kalisch EllettL, RamsayE, RougheadE (2018) The validity of the Rx-Risk Comorbidity Index using medicines mapped to the Anatomical Therapeutic Chemical (ATC) Classification System. BMJ Open8, e021122.
27.
CationsM, LangC, WardSA, CrottyM, InacioMC (2020) Dementia case ascertainment using aged care assessment data. Aust N Z J Public Health44, 517–518.
28.
CationsM, LangCE, WardSA, CrottyM, WhiteheadC, MaddisonJ, InacioM (2021) Cohort profile: Dementia in the registry of senior Australians. BMJ Open11, e039907.
Australian Bureau of Statistics (2013) Technical paper: Socio-Economic Indexes for Areas (SEIFA), 2011. ABS, https://www.abs.gov.au/ausstats/, Accessed September 20, 2017..
31.
JokanovicN, TanE, van den BoschD, KirkpatrickC, DooleyM, BellJ (2016) Clinical medication review in Australia: A systematic review. Res Soc Adm Pharm12, 384–418.
32.
SluggettJ, CaugheyG, AirT, MoldovanM, LangC, MartinG, CarterS, JacksonS, StaffordA, WesselinghS, InacioM (2022) Provision of a comprehensive medicines review is associated with lower mortality risk for residents of aged care facilities: A retrospective cohort study. Age Ageing22, 493.
33.
SluggettJ, BellJ, LangC, CorlisM, WhiteheadC, WesselinghS, InacioM (2021) Variation in provision of collaborative medication reviews on entry to long-term care facilities. J Am Med Dir Assoc22, 148–155.e1.
34.
McDerbyN, BailK, KosariS, ShieldA, PetersonG, DawdaP, NauntonM (2020) Canaries in the coalmine: Stakeholder perspectives of medication management reviews for residents with dementia. Res Soc Adm Pharm16, 1220–1227.
35.
SluggettJ, CollierL, BartholomaeusJ, InacioM, WesselinghS, CaugheyG (2021) National trends and policy impacts on provision of home medicines reviews and residential medication management reviews in older Australians, 2009-2019. Int J Environ Res Public Health18, 9898.
36.
LaverK, DyerS, WhiteheadC, ClemsonL, CrottyM (2016) Interventions to delay functional decline in people with dementia: A systematic review of systematic reviews. BMJ Open6, e010767.
37.
ScottI, CooperC, LevertonM, BurtonA, Beresford-DentJ, RockwoodK, ButlerL, RapaportP (2019) Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials. Int J Geriatr Psychiatry34, 1386–1402.
MitchellEKL, AngeloDA (2021) Recent trends in health assessments for older Australians. Austr J Prim Health27, 208–214.
40.
ChenZ, DingZ, ChenC, SunY, JiangY, LiuF, WangS (2021) Effectiveness of comprehensive geriatric assessment intervention on quality of life, caregiver burden and length of hospital stay: A systematic review and meta-analysis of randomised controlled trials. BMC Geriatr21, 377.
41.
VisvanathanR, AmareAT, LangC, KhadkaJ, YuS, BeilbyJ, WesselinghS, InacioMC (2021) Utilisation of general practice health assessments around an aged care assessment is associated with lower mortality risk in older Australians. Age Ageing50, 120–126.
42.
XiaoLD, HabelL, De BellisA (2015) Perceived challenges in dementia care by Vietnamese family caregivers and care workers in South Australia. ,. J Cross Cult Gerontol30, 333–352.
43.
HarrisMF, JayasingheUW, TaggartJR, ChristlB, ProudfootJG, CrookesPA, BeilbyJJ, DaviesGP (2016) Multidisciplinary team care arrangements in the management of patients with chronic disease in Australian general practice. Med J Aust194, 236–239.
44.
van GaansD, DentE (2018) Issues of accessibility to health services by older Australians: A review. Public Health Rev39, 20
45.
LebanoA, HamedS, BradbyH, Gil-SalmerónA, Durá-FerrandisE, Garcés-FerrerJ, AzzedineF, RizaE, KarnakiP, ZotaD, LinosA (2020) Migrants’ and refugees’ health status and healthcare in Europe: A scoping literature review. BMC Public Health20, 1039.
46.
MuC, HallJ (2020) What explains the regional variation in the use of general practitioners in Australia? . BMC Health Serv Res20, 325.
47.
ReligaD, FereshtehnejadSM, CermakovaP, EdlundAK, Garcia-PtacekS, GranqvistN, HallbackA, KaweK, FarahmandB, KilanderL, MattssonUB, NaggaK, NordstromP, WijkH, WimoA, WinbladB, EriksdotterM (2015) SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice. PLoS One10, e0116538.
48.
CationsM, LangC, WardSA, CaugheyGE, CrottyM, WhiteheadC, AhernS, MaddisonJ, InacioMC (2021) Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users. Sci Rep11, 10674.
