AS a researcher investigating aged care, I’m encouraged that the terms of reference for the Royal Commission into Aged Care Quality and Safety will leave few stones unturned. But, while the government and the public will have to wait at least 12 months for the Commission’s first interim report, there’s a wealth of information already available that could, and should, be telling us what is going wrong, where and why.
Australia’s aged care system is awash with data. Providers are required to routinely collect vast amounts of information about their clients and services. However, these separate data silos are rarely joined up or used to inform the many important decisions that could drive improvements in care. And as the data are rarely analysed in ways that are useful to frontline staff or management, their quality inevitably declines. As such, this huge bureaucratic undertaking is often reduced to a “tick a box” exercise of little value.
With a shift underway from those forgotten piles of paper to electronic records, we now have an invaluable opportunity to turn this around. As more aged care organisations adopt electronic records we have our best chance to date to “crowdsource” information in order to identify, predict and target problems, and to then monitor the effectiveness of improvement efforts.
Working with some of Australia’s largest aged care providers, we have been testing this approach. Using routinely collected electronic medication data from over 70 Australian residential aged care facilities, we have built a picture of the medications being used, including antipsychotic drugs. The recent ABC Four Corners investigation raised the alarm about the overuse of these drugs to “calm” or sedate residents who do not have a relevant mental health condition. What the data show are varying rates of use, which are partly explained by the different profile of residents in different facilities (these medications are right for some residents). But, the reasons for high rates of antipsychotic use in some facilities were less clear. With paper-based medication charts and paper-based data, medication practices remained opaque. But, electronic data can tell us where to focus our attention and, if necessary, institute changes.
Pressure injuries, another core measure of the quality of aged care, are largely preventable, excruciatingly painful and costly to manage. Without physically examining all residents in a facility or reviewing individual patient medical records it is impossible to determine the extent of the problem. But once clinical information is stored electronically, those data provide an accessible snapshot, both of the total numbers of injuries and the severity and location of wounds. Using pressure injury data from 60 Australian aged care facilities, we found 28% of residents, or over 1800 individuals, had at least one pressure injury over the past 2 years. Again, there was great variation, but we were able to conclude that 14% of aged care facilities in our data sample had higher rates of pressure injuries than could be expected, based on the profile of their residents; good reason for taking a closer look.
Analysing electronic medical records supersedes conventional ad hoc audits of patient records that provided information that was out of date by the time it was collected and analysed and, hence, virtually meaningless in informing improvements. Timelier crowdsourcing of the vast amount of existing data in the aged care sector would go a long way to providing a sector-wide picture and to identifying both good and poor quality care.
To realise this potential, we need to ensure new information technologies are being effectively and consistently used to target useful quality indicators, to monitor progress over time, and to move from descriptive to predictive quality indicators. We also need to make information available to all concerned. That’s not just policy makers and aged care providers and managers but also review agencies and families and residents themselves who want to make informed choices.
This could begin now; it does not need to wait for the Royal Commission to report.
Research also tells us we should put more energy into understanding what it takes to keep older Australians out of aged care; most older people say they want to avoid residential care for as long as possible. In a recent study, our team at Macquarie University found that community services in the home could be an effective alternative. For every extra hour of service received, the risk of admission to an aged care facility fell by 6%. Interestingly, it was social support, not health services, that were most strongly linked to staying at home. This is also worth remembering in the inevitable future scramble to announce new initiatives and policies to revive confidence in Australia’s aged care sector.
Johanna Westbrook is Professor and Director, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University. Her expertise is in patient safety and evaluation of the effects of health information and communication technology. She can be found on Twitter @JWestbrook91.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.