Measuring the Quality of Long-Term
institutional Care in Finland
Harriet Finne-Soveri,
Teija Hammar, Anja Noro
In collaboration
•
•
•
•
•
Harriet Finne-Soveri M.D., Ph.D., Adjunct professor in geriatric Medicine, University of Helsinki
Ageing and services, chief of the unit
National Institute for Health and Welfare (THL)
P.O.Box 30, Helsinki 00270, Finland
Email: [email protected]
•
•
•
•
•
Teija Hammar, D.Sc. (health economics)
Ageing and services, senior researcher
National Institute for Health and Welfare (THL)
P.O.Box 30, Helsinki 00270, Finland
Email: [email protected]
•
•
•
•
•
Anja Noro Ph.D, Adjunct professor in gerontology, University of Tampere
Ageing and services, research director
National Institute for Health and Welfare (THL)
P.O.Box 30, Helsinki 00270, Finland
Email: [email protected]
14/07/2017
Presentation name / Author
2
1. Grounded in 1st January 2009,
2. Maintains social and health registers for Finland
through legislation (including RAI)
3. 1300-1600 employees
4. Under the Ministry of Social Welfare and Health
5. Independent research activities
3rd May 2010
Harriet Finne-Soveri,
3
MD, PhD
Finland
Population: 5,2 millions, 65 + years of age 16%, 75+ years of age %
Member of EU since
1995
Republic: president
+ parliament
Monetary unit: Euro
Homeland of Nokia,
Kone, and high class
education (Pisa study)
& ice-hockey players
3rd May 2010
Harriet Finne-Soveri, MD, PhD
4
Contents
• Long/term care for
older persons
• RAI-benchmarking
project
• Results
• Conclusions
14/07/2017
Presentation name / Author
5
Quality-efficiency ladder, in the care for older
persons, in Finland
•
•
Boston summit
12th Nov 2009
Long-term care for
older persons, in
Finland, is delivered
either at home, in
sheltered housings,
residential homes
(nursing homes), or
health centre inpatient
wards (chronic care
hospitals).
In 2008, more than 10
% of those 75 years of
age or older received
24-hour care
elsewhere than in their
original homes and 6%
lived in institutions
Quality-efficiency ladder, in the care for older
persons, in Finland
Local authorities
Financer
• client
• local authorities
State
Financer
• client
• state
Boston summit
12th Nov 2009
RAI
• Minimum Data Set for
nursing homes 2.0
• Manual
• Guidelines
14/07/2017
Presentation name / Author
8
The RAI-benchmarking concept – Finland
Slide (modified): Magnus Björkgren
(current)
Responsibility of
Chydenius
Institute:
Training
Responsibility of
Raisoft Ltd:
Software
Responsibility of
STAKES
Benchmarking
9
interRAI instruments in Finland
MDS2,0
interRAI interRAI interRAI interRAI interRAI interRAI
MDS HC MH
CMH
AC
LTCF
ID
CA
2000
1826
2001
4235
2002
5530
2003
6164
991
2004
6384
1485
2005
6864
2491
2006
7093
3245
2007
9856
5302
2008
10677
9524
525
56
2009
11477
14207
2000
100
500
600
50
510
16000
14000
12000
10000
8000
6000
4000
2000
MDS-NH
2.0
MDS-HC
2.0
0
3rd May 2010
Harriet Finne-Soveri, MD, PhD
10
From the assessment to the impact
1. University of Wisconsin
(CHSRA) Quality Indicators
were chosen in 1999/2000 QIs
(total 26; 5 with risk
adjustment, 4 measuring
incidence 22 measuring
prevalence
2. Q-metrics
3. Mega QI’s
Quality Domains
•
The current official interRAI quality
indicators focusing on transitions:
What happens to the individual during
the care episode
•
•
Accidents
Behavioral & Emotional Patterns
•
•
•
•
•
Clinical Management
Cognitive Functioning
Elimination & Incontinence
Infection Control
Nutrition & Eating
•
•
•
•
Physical Functioning
Psychotropic Drug Use
Quality of Life
Skin Care
Source: www.CHSRA.wisc.edu/
Harriet FinneSoveri MD,
Ph.D
June
11
Casemix and functional capacity 20022009
Facilities (n=54) that joined in 2002/before and continued in 2008. Number
of assessments 82107
4.5
4
Cognitive
Performance
Scale (0-6)
3.5
3
Casemix
index (0,422,52)
2.5
2
ADLh (0-6)
1.5
1
0.5
0
Spring Fall Spring Fall Spring Fall Spring Fall Spring Fall Spring Fall Spring Fall Spring
2002
3rd May 2010
2003
2004
2005
2006
2007
Harriet Finne-Soveri, MD, PhD
2008
2009
12
Light care residents 2002-2009
Lightcare (PA)
12 %
10 %
8%
6%
4%
2%
0%
Spring
2002
3rd May 2010
Fall
Spring
2003
Fall
Spring
2004
Fall
Spring
2005
Fall
Spring
2006
Harriet Finne-Soveri, MD, PhD
Fall
Spring
2007
Fall
Spring
Fall
2008
13
2008 (all)
CCH & LTCF
n=95
2001
n=29
Deteriorated
2% or more
No change
(+/-2%)
Use of 9 or more different medications
Incidence of cognitive impairment
Prevalence of bowel/bladder incontinence
Any injury
Prevalence of falls within 30dd prior to the assessment.
Incidence of new fractures
Prevalence of synptoms of depression
Prevalence of synptoms of depression w/o antidepressant
Prevalence of indwelling catheders
Prevalence of weight loss 5% or more in the last 30 days or 10% or
more in the last 6 months
Prevalence of tube feeding
Prevalence of dehydration
Incidence of decline in late loss ADLs
Incidence of decline in Range of Motion
Prevalence of grade 1-4 pressurre ulcers
Improved
Prevalence of behavioral symptoms affecting others
Prevalence of occasional or frequent bowel/bladder incontinence
2-9%
w/o toileting plan
Prevalence of fecal impaction
Prevalence of urinary tract infections
Prevalence of bedfast residents
Lack of nursing rehabilitation in late-loss ADLs
Prevalence of antipsychotic use in absence of indication
Prevalence of daily physical restraints
Improved
Prevalence of antianxiety /hypnotic use
10 %or more
Prevalence of hypnotic use 3+ times/week
3rd May 2010 Prevalence of little or no activity
Harriet Finne-Soveri, MD, PhD
2008 CCH & LTCFs
included in 2001
n=29
34,9
11,1
68,2
25,5
9,9
0,8
34
41,4
15,2
72
26,4
8,7
1,1
32,2
41,8
14,9
71,2
25
8,6
1
31,9
14,9
5,6
15,9
4,7
15,6
5,4
7
0,8
1,7
23
17,22
9,8
39,8
7,3
1,3
2
24,4
17,9
8
34,2
7,8
1,2
1,9
23,3
16,8
8,8
34,4
64,9
14,3
14,3
29,5
28,4
35,6
20,3
58,4
40,8
65,5
49,5
9,2
8,8
24,6
28,8
27,1
16,7
38,7
18,9
56,4
49
8,8
8,7
25,8
22,3
27,2
16
38
18
14 52,1
Nine-year performance measure
follow-up of 29 facilities
14/07/2017
Presentation name / Author
15
Disability, pain, and nutrition during
2002-2008
100 %
90 %
Moderate+ dementia
(CPS=3+)
80 %
70 %
Severe dependency
(ADLh3+)
60 %
50 %
Moderate+ pain
(MDSPAIN 2+)
40 %
30 %
Undernurished (BMI<20)
20 %
10 %
Not weighed
2002
3rd May 2010
2003
2004
2005
2006
2007
Harriet Finne-Soveri, MD, PhD
Fall
Spring
Fall
Spring
Fall
Spring
Fall
Spring
Fall
Spring
Fall
Spring
Fall
Spring
0%
2008
16
Summary and conclusions-1
•
•
•
•
Burden of care has slightly increased in the units
Incontinence and pain need special attention
Reducing restraints is a further issue
Improvement seen in
–
–
–
–
–
–
•
•
nutritional procedures and outcomes
fall prevention
pressure ulcers
psychotropic medications
nursing procedures such as rehabilitative care
possibilities for social life have increased slightly
Further analyses are needed to unveil the nature of these changes
We are on the right way but not there yet
3rd May 2010
Harriet Finne-Soveri, MD, PhD
17
Summary and conclusions-2
•
•
•
Quality of care and cost of it are not always contradictory
Use of standardized data gathering and documenting instruments,
such as RAI, is a useful method of gathering comparable
information from different care providers in the elderly care sector,
particularly in the cases, where municipalities have substantial
independence.
When data gathering is further used for quality improvement
purposes, benchmarking might thoroughly chance the care
delivered for older persons.
3rd May 2010
Harriet Finne-Soveri, MD, PhD
18