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

Hibbert, Peter D., Molloy, Charlotte J., Cameron, Ian D., Gray, Leonard C., Reed, Richard L., Wiles, Louise K., Westbrook, Johanna, Arnolda, Gaston, Bilton, Rebecca, Ash, Ruby, Georgiou, Andrew, Kitson, Alison, Hughes, Clifford F., Gordon, Susan J., Mitchell, Rebecca J., Rapport, Frances, Estabrooks, Carole, Alexander, Gregory L., Vincent, Charles, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699, Wagner, Cordula, McCormack, Brendan and Braithwaite, Jeffrey 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) , 22. 10.1186/s12916-023-03224-8

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/, Type: open-access
Publisher:	BioMed Central
ISSN:	1741-7015
Date of First Compliant Deposit:	24 January 2024
Date of Acceptance:	12 December 2023
Last Modified:	24 Jan 2024 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/165799

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