Abstract
Background: Patient transitions, such as transfers between acute and long-term care (LTC), are times when the likelihood of communication failure between healthcare providers is increased. Employing appropriate health quality indicators helps support improvement efforts. To date, few quality indicators that evaluate the continuity of medication use between acute and LTC facilities have been described.
Objective: The aim of the study was to develop quality indicators signalling the potential discontinuation of previously prescribed medications for chronic diseases when residents return to LTC following an acute-care hospitalization.
Methods: A literature review for the selection of potential indicators was conducted, followed by a three-step process: (i) initial screening round that rated the indicators; (ii) a 1-day in-person consensus meeting in which the panel refined the parameters regarding the proposed quality indicators; and (iii) a final anonymous survey that assessed consensus among panel members. The study setting was a survey and consensus meeting with national representation, held in Toronto, ON, Canada. A ten-member expert panel with broad geographical and clinical representation participated and was made up of registered nurses, physicians, pharmacists, policy makers and academic researchers. A 75% agreement threshold was required for consensus, as measured on a 9-point Likert-type scale. The panel evaluated quality indicators for effectiveness, relevance and feasibility, using currently available healthcare administrative data.
Results: The panel reached consensus on four quality indicators to assess the unintentional discontinuation of medications prescribed to LTC residents for chronic diseases upon return to LTC after an acute-care admission. The selected indicators were (i) HMG-CoA reductase inhibitors (statins) for all indications; (ii) anticoagulants (e.g. warfarin) for the indication of atrial fibrillation; (iii) proton-pump inhibitors for the indication of post-gastrointestinal haemorrhage; and (iv) thyroxine for all indications. The panel identified three additional treatment groups for future consideration as quality indicators: anti-Parkinson’s disease, anti-diabetes and antidepressant medications.
Conclusion: A novel set of quality indicators has been developed to evaluate medication continuity between acute and LTC facilities. The adoption and implementation of these indicators in clinical practice can help inform quality improvement efforts at various local and regional levels.
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Acknowledgements
The consensus process was funded by a Canadian Institute of Health Research (CIHR) Meetings, Planning and Dissemination grant (♯101931). Dr Bell is supported by a CIHR/Canadian Patient Safety Institute (CPSI) Chair in Patient Safety and Continuity of Care. Ms Brener is supported through a CIHR Master’s Award in the Area of Primary Care. Dr Bronskill is supported by a CIHR New Investigator Award in the Area of Aging. Ms Comrie and Dr Anderson have no relevant financial interests to disclose.
The funding organization and sponsors had no role in the design, conduct or analysis of the study; nor any role in the preparation or approval of the manuscript.
No researcher or panel member involved in this study had any declared or otherwise known conflicts of interest, including any with regards to the selection of any single drug or drug groups.
We wish to thank the study participants: Christina Bath (The Villa Care Centre & Retirement Lodge); Becky Briesacher (University of Massachusetts); Ben Chan (Ontario Health Quality Council); Karen Cronin (Kipling Acres); Ed Etchells (Sunnybrook Health Sciences Centre); Olavo Fernandes (University Health Network); Jane Froese (Revera); Sudeep Gill (St Mary’s of the Lake Hospital); Nathan Hermann (Sunnybrook Health Sciences Centre); Jonathan Mitchell (Accreditation Canada); Ingrid Sketris (Dalhousie University, College of Pharmacy); and Gary Teare (Health Quality Council of Saskatchewan).
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Bell, C.M., Brener, S.S., Comrie, R. et al. Quality Measures for Medication Continuity in Long-Term Care Facilities, Using a Structured Panel Process. Drugs Aging 29, 319–327 (2012). https://doi.org/10.2165/11599150-000000000-00000
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DOI: https://doi.org/10.2165/11599150-000000000-00000