CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol

Abstract

IntroductionThe aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims ofCareTrack Agedare to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia.Methods and analysisWe will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in theCareTrack Agedmethods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires.Ethics and disseminationThe study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.

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

“…The CareTrack Aged study methods have been published elsewhere [17,18]. We reviewed a sample of 294 care records of LTC residents aged ≥ 65 years as of March 1st 2021, against indicators derived from CPG recommendations for care delivered between 1 March 2021 and 31 May 2021 (our record review period).…”

Designing clinical indicators for common residential aged care conditions and processes of care: the CareTrack Aged development and validation study

“…As outlined in our protocol, we determined which conditions and processes of care were to be included in the study (26). Fifteen conditions and processes of care were identified for inclusion, through use of published research, prevalence and burden of disease data, CPGs, and indicator sets relevant to RACF settings (26).…”

“…The remaining indicators were described in a structured and standardised format, commencing with inclusion criteria (e.g., condition, phase of care [e.g., at diagnosis]), followed by the compliance action (e.g., the recommended appropriate care) (see box 2) (23,26).…”

“…The CT Aged study indicators have three primary uses -research, quality improvement, and quality assurance. First, they can be used to undertake a population-level study of appropriateness of care delivered to residents, as is being conducted in the next phase of the CT Aged study (26). Related to this, using the indicators for research to understand the local uptake or variation in appropriateness of care and, particularly, local organisational factors that may impact on this uptake is important for systematic and spread of improvement.…”

Incidence of adverse incidents in residential aged care

“…Using key information already captured in management systems would also enable the reporting of a broader range of indicators, providing a comprehensive assessment of adverse incidents in aged care while minimising the administrative burden on aged care staff and management to capture information and develop additional reporting mechanisms. 37 The missing voice of residents What is limited in the aged care adverse incident research literature and in incident reports is residents' reflections on the way they view the incident and its impact (aside from any injury) on them. For example, little is known about how a fall affects a resident's wish to balance the need to avoid the potential for falls with their right to take reasonable risks.…”