What is FOCUS on Healthcare?

FOCUS stands for “Fostering Open Conversations that Unleash Solutions”. This website is one area of the FOCUS on Healthcare website. FOCUS on Healthcare: Long Term Care gives a snapshot of what Albertans experience as residents in this area of continuing care, so that providers, decision-makers, and the public can have informed conversations about improvements in this area of Alberta’s healthcare system.

How do I use the FOCUS on Healthcare: Long Term Care website?

There is a series of three videos to help understand how to navigate the FOCUS on Healthcare: Long Term Care website.

If you still need help navigating the website, please contact the HQCA at info@hqca.ca.

How can I use the information on the website?

The website presents measures in the form of interactive charts. The key measures were determined through robust stakeholder consultations to ensure they described important aspects of resident experience and quality of care and reflect on the functioning of the long term care system. The interactive charts for the experience measures allow you to see information for a site relative to comparable sites. You can see results for a selected site in relation to other sites that are located in the same zone and geographic setting (i.e., urban or rural), and are similar by operator type and size. By looking at the charts, you can review your results relative to others and then start a conversation about why the results may be different and start to explore where there are opportunities for improvement. On the website, beside each chart there are prompting questions that help you interpret and use the results. Beneath each chart there is detailed information about the chart being looked at and more specific prompting questions to consider as you reflect on the information.

Does the HQCA provide info about other healthcare settings?

Yes, please visit the FOCUS on Healthcare page to see what areas of healthcare the HQCA is currently measuring and reporting on and what areas will be coming in the future. The HQCA also provides information about other aspects of our healthcare system through surveys, studies, and reviews which are available on the main HQCA website.

What areas of continuing care are reported on FOCUS on Healthcare?

FOCUS on Healthcare reports information about long term care, designated supportive living, and home care.

How often is the information on the FOCUS on Healthcare: Long Term Care website updated?

The information is updated annually, quarterly, or every three years, depending on the chart/measure.

What is long term care?

Long term care is a type of continuing care service for people who have highly complex and unpredictable health needs whose care cannot be safely provided in their own home or in a supportive living site. Registered nurses (RNs) supervise care and professional nursing services may be provided by licensed practical nurses (LPNs). There is 24-hour onsite (unscheduled and scheduled) professional nursing and personal care staff. Long term care is provided in nursing homes and auxiliary hospitals, which FOCUS on Healthcare: Long Term care will refer to as “long term care sites” or “sites.”

Individuals become eligible for a space or a room in long term care based on an assessment of their needs by Alberta Health Services (AHS) using a standardized tool which identifies an individuals’ health care needs, and the type or level of care that is needed to meet these needs.

What is a quality indicator?

A quality indicator is a standardized measure of quality that can be used to track clinical performance and outcomes. Quality indicators are often used for public reporting, by care providers to improve care, and system leaders to monitor care and inform decision-making.

FOCUS on Healthcare: Long Term Care reports the interRAI quality indicators. These quality indicators are derived using information that is collected from individuals living in long term care using a standardized assessment instrument that is completed by a trained assessor. While the information is initially collected at the individual-level, it can be expressed as an average at a site, zone, or provincial level.

Quality indicators, when studied as a group or whole over time, can signal the need to improve quality and safety.

Why is the falls quality indicator not reported on FOCUS on Healthcare: Long Term Care?

The quality indicator on falls is not reported on FOCUS on Healthcare: Long Term Care because it is difficult to interpret the information reported by this indicator.

A high score at a site on this indicator means that there is a high incidence of falls, which does not necessarily provide enough information to comment on the quality of care at a site. For example, a site may see higher scores, because they are honouring residents’ wishes to accept risk and implementing rehabilitative efforts to improve mobility. These are actions that may increase falls. Falling is also an inevitable outcome of aging-related changes that occur over time. Therefore, it is difficult to understand what a high score on this indicator tells us and whether improvement is needed.

Why is resident and family experience important to overall health system quality?

The Institute for Healthcare Improvement (IHI) has developed the Triple AIM Framework to describe an approach for optimizing health system performance. This framework has three components: (1) Experience of Care, (2) Population Health, (3) Per Capita Cost. The HQCA’s survey and Alberta Health Services (AHS) and Alberta Health administrative data used throughout this website comprise the patient, or in this case resident, experience element for long term care and can be used in working towards addressing the Triple Aim, and improving Alberta’s health system.

Patient/resident experience, as described in the Framework, includes but is also more than what is measured in patient satisfaction or experience surveys. It also encompasses their experience across the dimensions of quality. These quality dimensions are captured in the Alberta Quality Matrix for Health: Acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.

Will the HQCA be adding more measures to FOCUS on Healthcare: Long Term Care in the future?

In deciding whether to add new measures, we work with our stakeholders to identify new topics of interest and what information is needed to describe how our health care system functions. We look at whether the data is available to create the new measures, and consider if the measure can be presented in a way that starts a conversation about improvement. Moving forward, we are committed to continuing to work with our stakeholders to identify new measures.

Who will be acting on the information in this website?

Healthcare improvement is a complex process that involves people at all levels of the healthcare system. Many sources of information are used to identify where improvement is needed, decide where to focus improvement efforts, select solutions that might work, and then determine if the change was an improvement. The measures on this website are only one source of information that can be used to identify where improvements are needed and to identify areas of success.

Improvement in the quality of care provided in long term care are typically made at the site level. Therefore, leaders and managers at the long term care site are the ones who will most likely act on information in this website. However, quality of care is also the result of services provided in other areas of the healthcare system, such as primary care, the emergency department, and acute care (hospitals). Leaders and managers in these other areas of the healthcare system can also support conversations to target improvement efforts in long term care.