Table 2.
Description of Home Care Quality Indicators including Stratification and Adjustment Covariates
| HCQI | Description, stratification and adjustments |
|---|---|
| ADL improvementa | Clients with baseline impairment and a better score on the ADL long form. |
| Stratification: IADL capacity scale score | |
| Adjusted for: not independent cognition, ADL decline, clinical risk, falls, hospitalizations, ADL hierarchy scale score | |
| ADL declinea | Clients with a score of less than 18 on the baseline ADL long form who decline further. |
| Stratification: IADL summary scale | |
| Adjusted for: difficulty with meal preparation, housework and bathing, unsteady gait, Cognitive Performance Scale score, institutional risk, ADL hierarchy scale score | |
| Bladder declinea | Clients who experienced a decline in bladder continence (baseline score is less than 5 and lower than follow-up score). Includes clients who developed a new bladder continence problem. |
| Stratification: IADL performance scale | |
| Adjusted for: difficulty with meal preparation, clinical risk, ADL hierarchy scale score, age over 80 years | |
| Bladder improvementa | Clients who experienced an improvement in bladder continence (baseline score greater than 0 and greater than follow-up score). |
| Stratification: ADL hierarchy scale score | |
| Adjusted for: not independent cognition, sadness, difficulty bathing, ADL decline, hospitalizations, institutional risk | |
| Cognitive improvementa | Clients with some baseline cognitive impairment on the Cognitive Performance Scale who experience an improvement. |
| Stratification: IADL summary scale | |
| Adjusted for: difficulty with phone use, impaired decision making, Alzheimer’s diagnosis, clinical risk, not independent cognition, less than 2 h of activity daily, Cognitive Performance Scale score | |
| Cognitive declinea | Clients with a score of less than 6 on the Cognitive Performance Scale at baseline who experience a further decline. Includes clients who experience a new cognitive impairment. |
| Stratification: IADL performance scale | |
| Adjusted for: difficulty with phone use, managing finances, meal preparation and bathing, falls | |
| Communication improvementa | Clients with some difficulty in the communication scale (problems understanding others or making themselves understood) at baseline who experience an improvement (lower score on the communication scale). |
| Stratification: IADL capacity scale | |
| Adjusted for: dementia (both Alzheimer’s and non), clinical risk, sadness, Cognitive Performance Scale score, ADL hierarchy scale score, age over 80 years | |
| Communication declinea | Clients with a score of less than 8 on the communication scale at baseline who experience a decline (higher score on the communication scale). Includes clients with new difficulties in communication |
| Stratification: IADL performance scale | |
| Adjusted for: difficulty managing finances, managing medications, and with phone use, Alzheimer’s disease, clinical risk, ADL hierarchy scale score | |
| Falls | Clients who experienced one or more falls in the last 90 days. |
| Stratification: clinical risk | |
| Adjusted for: use of assistive device, unsteady gait, ADL hierarchy scale, age over 80 years | |
| IADL improvementa | Clients with a score greater than 0 on the IADL self-performance summary scale at baseline who experience an improvement (lower score). |
| Stratification: clinical risk | |
| Adjusted for: sadness, ADL decline | |
| IADL declinea | Clients with a score less than 15 on the IADL self-performance summary scale at baseline who declined (had a higher score). |
| Stratification: clinical risk | |
| Adjusted for: difficulty with meal preparation and housework, institutional risk, ADL hierarchy scale score | |
| Injuriesa | Clients with new injuries - fractures, second- or third-degree burns or unexplained injuries – since baseline. |
| Stratification: clinical risk | |
| Adjusted for: ADL decline, pain, unsteady gait | |
| Mood improvementa | Clients with fewer depressive symptoms on the Depression Rating Scale at follow-up. |
| Stratification: IADL summary scale | |
| Adjusted for: ADL decline, hospitalizations, depression rating scale score | |
| Mood declinea | Clients with more depressive symptoms on the Depression Rating Scale at follow-up. Includes clients with new depressive symptoms. |
| Stratification: ADL hierarchy scale | |
| Adjusted for: clinical risk, difficulty bathing, institutional risk | |
| Pain not controlled | Clients who have pain and are receiving inadequate pain control or no pain medication. |
| Adjusted for: clinical risk | |
| Pain improvementa | A reduction in pain since baseline. |
| Stratification: clinical risk | |
| Adjusted for: unsteady gait, Cognitive Performance Scale score | |
| Daily severe paina | Individuals with at least daily episodes of severe pain at follow-up. |
| Stratification: clinical risk | |
| Adjusted for: dyspnea, unsteady gait, ADL long form score, ADL short form score, depression rating scale score | |
| Continued caregiver distress | Clients with caregivers who express distress, anger and or depression at baseline and follow-up. |
| Stratification: Cognitive Performance Scale score | |
| Adjusted for: not independent cognition, IADL difficulty, difficulty with locomotion, impaired decision making, difficulty with housework, clinical risk | |
| Alone and distresseda | Clients who are distressed by a decline in social activities and are alone for long periods or all the time at follow-up. |
| Stratification: clinical risk | |
| Adjusted for: not independent cognition, pain, unsteady gait, Cognitive Performance Scale score, ADL hierarchy scale score, depression rating scale score | |
| Used to go outa | Clients who compared to the baseline assessment, go out less or not at all. |
| Adjusted for: IADL difficulty, Cognitive Performance Scale score | |
| No flu vaccine | Clients who did not receive an influenza vaccination at either baseline or 6-month follow-up assessments |
| Stratification: clinical risk | |
| Adjusted for: less than 2 h of daily activity, institutional risk, Cognitive Performance Scale score, depression rating scale score | |
| Hospitalization and Emergency Department usea | Clients who have been hospitalized or visited the emergency department in the 90 day period before the follow-up assessment. |
| Stratification: IADL capacity scale score | |
| Adjusted for: physician visits, clinical risk, diabetes, depression rating scale score | |
| Weight lossa | Clients with any unintended weight loss at follow-up. |
| Adjusted for: clinical risk |
Abbreviations: ADL activities of daily living, IADL instrumental activities of daily living
aMeasured at the 6-month follow-up assessment