Table 1

Quality indicators for the interRAI LTCF instrument
# 1 Indicator Numerator 2 Denominator exclusions 3 Risk adjustment FAP 4
Prevalence indicators
Mental functions
beh01 Behaviour problem prevalence 5 Behaviour symptoms Comatose. +
beh02 High risk behaviour problem prevalence Behaviour symptoms Comatose. +
Low risk behaviour (see beh03)
beh03 Low risk behaviour problem prevalence Behaviour symptoms Comatose. +
Dependent in daily decision making or short term memory problem. Schizophrenic or bipolar depression.
dep01 Depression prevalence Depression Ration Scale score > = 3
Health problems
cnt01 Bladder/bowel incontinence prevalence Frequent or always bladder or bowel incontinent Comatose, end-stage disease or hospice care. +
cnt05 High risk bladder/bowel incontinence prevalence Frequent or always bladder or bowel incontinent Comatose, end-stage disease or hospice care. +
Low risk incontinence (see cnt06)
cnt06 Low risk bladder/bowel incontinence prevalence Frequent or always bladder or bowel incontinent Comatose, end-stage disease or hospice care. +
Severely impaired decision making and short term memory problem.
Total ADL dependence in bed mobility, transfer toilet or locomotion.
cnt04 Urinary tract infection UTI End-stage disease or hospice care.
inf01 Infections prevalence Pneumonia, COPD, septicemia, Sexually transmitted disease, UTI or viral hepatitis End-stage disease or hospice care. +
nut01 Feeding tube prevalence Comatose, end-stage disease or hospice care. (1) Swallowing problem and stroke +
bmi0x Low body mass index prevalence bmi < = 19 End-stage disease or hospice care. +
pai01 Inadequate pain management prevalence Daily moderate or worse pain (1) Dependent in daily decision making +
pru01 Pressure ulcer prevalence PU +
pru02 High risk pressure ulcer prevalence PU Comatose. +
Low risk PU (see pru03)
pru03 Low risk pressure ulcer prevalence PU Comatose. +
Extensive assistance or more with toilet transfer or bed mobility.
bur0x Burns, skin tears or cuts prevalence Burns, skin tears or cuts +
Treatments and procedures
soc02 Little/no activity prevalence Little or no time involved in activities Comatose, end-stage disease or hospice care.
drg01 Antipsychotic prevalence Use of antipsychotic(s) End-stage disease or hospice care. +
Psychotic disorder.
drg02 High risk antipsychotic prevalence Use of antipsychotic(s) End-stage disease or hospice care. +
Low risk AP (see drg03)
drg03 Low risk antipsychotic prevalence Use of antipsychotic(s) End-stage disease or hospice care. +
Psychotic disorder.
Dependent in daily decision making.
Short term memory problem.
Behaviour symptoms score.
adp01 Antidepressant prevalence Use of antidepressant(s) +
vac01 Influenza vaccination prevalence Influenza vaccination in last 12 months
cat02 Indwelling catheter prevalence Indwelling catheter End-stage disease or hospice care. (1) Frequent or always bowel incontinent
(2) Stage 3+ PU
res01 Physical restraints use prevalence Daily used trunk restraint or chair that prevents rising
Incidence indicators
Physical functions
adl01 Late-loss ADL decline Scores as compared to previous scores 6 for bed mobility, transfer toilet, eating, toilet use: +1 on at least two of the items or +2 on one item. Comatose, end-stage disease or hospice care.
At previous assessment such a (high/low) score on items that numerator conditions cannot be met. 7
adl02 ADL decline following an improvement Score on adl-lf 8 lower than previous AND score on previous adl-lf higher than at the assessment before previous. Comatose, end-stage disease or hospice care.
adl03 ADL improvement Score on adl-lf lower than previous Comatose, end-stage disease or hospice care.
Person or caregivers do not believe improvement possible.
mob01 Locomotion worsening Score on locomotion adl higher than previous Comatose, end-stage disease or hospice care. (1) Fell +
(2) Extensive assistance eating
(3) Extensive assistance toilet use
fal01 Falls increase Fell in last 30 days At previous assessment not a fall in last 30 days (1) Bedbound
(2) Wandering behaviour
(3) Unsteady gait and cps > =2
Mental functions
cog01 Cognitive decline Score on cps higher than previous Comatose, end-stage disease or hospice care. (1) Frequent or always bowel incontinent +
(2) Fell in last 30 days
(3) Weight loss
(4) 76+ years old
com01 Communication decline Score on making self understood + ability to understand others higher than previous Comatose, end-stage disease or hospice care. (1) Extensive assistance eating +
(2) Short term memory
del01 Delirium new or persistent Score of 2 on one or more of the delirium items OR a previous score of 2 and now 1 OR now score of 1 and cps < 4 Comatose, end-stage disease or hospice care. +
beh04 Behaviour problem decline Sum of behaviour symptoms scores higher than previous Comatose (1) Not aphasia +
Previous score of 0 on all of the behaviour symptoms (2) Moderate or severe decision making problem
Health problems
cnt02 Bowel continence decline Score on bowel incontinence higher than previous Comatose, end-stage disease or hospice care. (1) Short term memory
(2) Extensive assistance dressing
(3) Frequent or always bladder incontinent
cnt03 Bladder continence decline Score on bladder incontinence higher than previous Comatose, end-stage disease or hospice care. (1) Short term memory +
(2) Extensive assistance dressing
(3) Severely impaired decision making
(4) Weight loss
wgt01 Weight loss 5% or more weight loss in last 30 days or 10% or more in last 180 days End-stage disease or hospice care. (1) Long term memory +
Participant in weight loss program. (2) Extensive assistance bed mobility
(3) Daily or almost daily physically aggressive
pan01 Pain worsening Score on pain frequency higher than previous (1) Dependent in daily decision making +
pru04 Pressure ulcers worsening Score on PU stage higher than previous (1) Extensive assistance with toilet transfer +
(2) Fluctuating, precarious, deteriorating condition
(3) Extensive assistance with bed mobility
(4) Extensive assistance with locomotion
Treatments and procedures
cat01 New indwelling catheter Score on indwelling catheter higher than previous End-stage disease or hospice care. (1) Frequent or always bowel incontinent
(2) Stage 3+ Pressure Ulcer

1 Mnemonics for the quality indicators from megaQI project [5].

2 The ADL’s with a 0 – 6 range in the interRAI LTCF have first been recoded into a 0 – 4 range as in RAI/MDS 2.0.

3 Condition at target assessment unless stated differently.

4 FAP = Facility Admission Profile. FAP-adjustment means correction on the basis of score of the numerator items at admission, if admission occurred in last five quarters.

5 All prevalence indicators are calculated at only one, the last, assessment where the person had stayed 30+ days in the facility.

6 When an assessment is compared with a previous assessment 6 assessments can be considered, i.e. the target assessment as compared to the previous one; the previous one as compared to the one before that, and so on. It means that in theory a person can be counted 5 times in the calculation of a QI.

7 This condition or a similar condition applies to all of the indicators.

8 The following scales are used: adl-long form [16], cognitive performance scale [17] and depression rating scale [18].

Frijters et al.

Frijters et al. BMC Health Services Research 2013 13:138   doi:10.1186/1472-6963-13-138

Open Data