“We’ve got the home care data, what do we do with it?”: understanding data use in decision making and quality improvement

Abstract

Background: In the past decade the provision of home care services in Canada has doubled; with this increase there has been a growing interest in improving quality and safety. National-level data are captured in the Home Care Reporting System (HCRS), using the interRAI-HC tools. Data in the HCRS provide decision-makers and administrators with actionable evidence to inform quality and safety improvement initiatives. The objective of this study was to determine how providers and administrators were using these data, and if there were any opportunities to enhance their use. Methods: We collaborated with the Canadian Patient Safety Institute to conduct this qualitative study. To understand data use in home care, we recruited participants in management and/or data analysis roles from home care organizations across Canada. We conducted three individual interviews and three focus group interviews with a total of eleven participants from five Canadian provinces. Individual and focus group interviews were audio recorded, transcribed, and analysed using a combination of emergent coding and thematic analysis. Results: Several participants provided powerful examples of how interRAI data have been used to guide patient safety and quality improvement initiatives; however, all participants recognized challenges in using these data. Leveraging interRAI data in the complex home care environment is limited by several factors: the general "newness" of these data in many jurisdictions; the sheer volume of data; limited capacity and resources to interpret and analyse the data; and connectivity issues in rural areas. Participants recognized and appreciated the training that has been provided, and made several recommendations for additional training. Conclusions: Mandated clinical datasets, such as the suite of interRAI tools, have the potential to improve quality and inform decision-making. However, in order to utilize these data, home care agencies require additional education, personnel and supports. Additional training and resources for these organizations could improve the use of available data by home care agencies, as well as outcomes for individuals receiving home care services.

Quality and safety indicators for home care recipients in Australia: development and cross-sectional analyses

“…A recent Canadian study reported the use of quality indicator data to guide patient safety and quality improvement initiatives, specifically in the areas of antipsychotic use, management of pain and falls mitigation strategies. 21 …”

“…25 This lack of discrimination between types of home care services provided and implementation of home care quality indicators may, in part, be attributable to some of the identified barriers to optimal utilisation internationally. 21 …”

“…A recent Canadian study reported the use of quality indicator data to guide patient safety and quality improvement initiatives, specifically in the areas of antipsychotic use, management of pain and falls mitigation strategies. 21 Australian Government has pledged to introduce quality indicators for home care by the end of 2022 but is likely to include a minimal number of indicators similar to the current residential aged care National Mandatory Quality Indicator Program. 22 23 Use of administrative claims data as included in the current study provides data sources to support a timely, comprehensive and flexible quality indicator monitoring strategy that can be integrated into care delivery planning with minimal additional data collection burden.…”

“…25 This lack of discrimination between types of home care services provided and implementation of home care quality indicators may, in part, be attributable to some of the identified barriers to optimal utilisation internationally. 21 Comprehensive chronic disease management plans, access to medication reviews and timeliness of service provision (wait-time) were identified by the Royal Commission's Final Report as key areas of focus needed to improve quality of care for home care recipients. 4 Chronic disease management plans have been shown to reduce the risk of hospitalisation 26 and, together with a health assessment, reduce the risk of mortality in older people receiving HCP.…”

Development and testing of the Geriatric Care Assessment Practices (G-CAP) survey

“…However, as the overall structure of the Ontario home care system has remained largely unchanged since that time, the findings are believed to be relevant to current care practices. A recent study on the use of home care assessment data in the home care sector confirms this relevance, indicating that these data are both undervalued and underutilized for evidence-informed decision-making across the sector [ 74 ].…”