Clinical Quality Indicators for Monitoring Hospitalizations Among Older People with Dementia Accessing Aged Care Services

Abstract

Background: There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer’s disease and other forms of dementia. Objective: To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia accessing aged care services and determine 1) annual trends in CQI incidence between 2011–2012 and 2015–2016, 2) associated factors, and 3) geographic and facility variation in CQI incidence. Methods: This retrospective repeated cross-sectional study included non-Indigenous individuals aged 65–105 years who lived with dementia between July 2008-June 2016, were assessed for government-funded aged care services, and resided in New South Wales or Victoria (n = 180,675). Poisson or negative binomial regression models estimated trends in annual CQI incidence and associated factors. Funnel plots examined CQI variation. Results: Between 2011–2012 and 2015–2016, CQI incidence increased for falls (11.0% to 13.9%, adjusted incidence rate ratio (aIRR) 1.05 (95% CI 1.01–1.06)) and delirium (4.7% to 6.7%, aIRR 1.09 (95% CI 1.07–1.10)), decreased for unplanned hospitalizations (28.7% to 27.9%, aIRR 0.99 (95% CI 0.98–0.99)) and remained steady for fracture (6.2% to 6.5%, aIRR 1.01 (95% CI 0.99–1.01)) and pressure injuries (0.5% to 0.4%, aIRR 0.99 (95% CI 0.96–1.02)). Being male, older, having more comorbidities and living in a major city were associated with higher CQI incidence. Considerable geographical and facility variation was observed for unplanned hospitalizations and delirium CQIs. Conclusions: The CQI results highlighted considerable morbidity. The CQIs tested should be considered for application in clinical quality registries to monitor dementia care quality.