MED e-care

15

Enterprise Reporting Outcomes: Census, Care, Medication, and Resource

Dr. A. P. Beaulne

Contents Accessing the Enterprise Reporting System .................................................................................................................................................................................... 1

MED e-care Dashboard ................................................................................................................................................................................................................ 2

Enterprise Business Intelligences ..................................................................................................................................................................................................... 3

Demographics .................................................................................................................................................................................................................................. 0

Occupancy by Care Home ............................................................................................................................................................................................................ 0

Gender ......................................................................................................................................................................................................................................... 0

Marital Status ............................................................................................................................................................................................................................... 0

AGE ............................................................................................................................................................................................................................................... 0

Quality Indicators ............................................................................................................................................................................................................................. 1

Graphical Display with Capability to Drill Down from Province to Region, to Home to Nursing Unit ......................................................................................... 3

Top 3 Homes with Care Concerns by QI ...................................................................................................................................................................................... 6

Trending Quality over Time ......................................................................................................................................................................................................... 8

Medication Outcomes.................................................................................................................................................................................................................... 10

Relative Resourcing Model Based on Clinical Assessment ............................................................................................................................................................ 12

1

Accessing the Enterprise Reporting System

After signing into the MED e-care Application, from the Home Page click on the Dashboard link on the Green Menu Bar (See Figure 1).

Figure 1 EHR Home Page

2

MED e-care Dashboard From the Dashboard you are able to view and access all current tasks that need to be addressed or enter the Enterprise Business Intelligence (EBI)

application (See Figure 2)

Figure 2 Accessing EBI

3

ALL INFORMATION IS IN REAL TIME. THUS ANY INFORMATION ENTERED EVEN MINUTES BEFORE IS AUTOMATICALLY AVAILABLE TO THE USER

Enterprise Business Intelligences Once you have entered the EBI navigation to the outcomes of interest it is simply a matter of clicking on the given group (See Figure 3).

The current example is limited to only 3 groups of outcomes, but other grouping can be made available such as Financial, Medications, Orders etc..

Figure 3 EMI Outcomes Demographics, Quality and Funding

4

Demographics

Occupancy by Care Home

Name Beds Population Occupancy

Home 1 83 81 97.59% Home 2 63 60 95.24%

Home 3 165 158 95.76%

Home 4 160 160 100.00%

Home 5 44 42 95.45%

Home 6 45 45 100.00%

Home 7 49 47 95.92%

Home 8 61 59 96.72%

Home 9 68 68 100.00%

Home 10 66 65 98.48%

Home 11 47 47 100.00%

Home 12 120 110 91.67%

Home 13 121 119 98.35%

Home 14 126 122 96.83%

Home 15 79 75 94.94%

Home 16 60 58 96.67%

Home 17 84 82 97.62%

Total 1441 1398 97.02%

Figure 4 Homes falling below 95% Occupancy

Gender Figure 5 Gender Count and Percentage

G

Gender Count Percentage

Female 803 69

Male 360 31

Total 1165

Marital Status Figure 6 Marital Status

AGE Figure 7 Age Distribution

1

Quality Indicators The 35 QIs are organized into 3 major groups or types of indicators: 1) Prevalence or assessments where one considers only the current quarter, 2) Incident

Decline in health status where 2 assessments are needed and 3) Incident Improvement in health status also where 2 assessment are needed. The table

provides comparative results at any level chosen by the enterprise such as Province, Region, Enterprise and Home. Homes could either experience a result

that is superior to the Comparative Group (Province) or inferior to the Comparative Group (Province). In Figure 8 it can be seen that the user is able to

select any date range of interest. In addition there are 4 quick date ranges – Last Quarter (selects data from 3months prior to the current quarter) – Year to

Last Quarter (selects data from the 12 months prior to the current quarter) – Current Quarter (selects all data entered in the current quarter) – Year to

Current Quarter (selects all data from the 9 months prior to the current quarter plus any data entered to date in the current quarter).

The user can also select one of 2 predefined comparative groups that each homes results can be benchmarked against. In this example, Care Home 1 to

Care Home 16 is compared to the Column titled Province. Note that the first 9 QIs measure the degree to which a resident’s functional status have

Improved since the last assessment. For example 2: “Improved or remained independent in mid-loss ADL (ADL05)” the Provincial average is recorded as

24.7% of resident population have Improved or Remained Independent in their functional status related to Mid-Loss ADL. Each care home that

underperformed (a lower score) compared to the Province is coloured in RED. While the care homes that Outperformed the province (a high score) are

displayed in GREEN.

Finally, the user can also select a different set of benchmarks by clicking on the drop down box.

Figure 8 RAI 35 Quality Indicators by Enterprise, Region and Care Home

QI Province Corp. HM 01 HM 02 HM 03 HM 04 HM 05 HM 06 HM 07 HM 08 HM 09 HM 10 HM 11 HM 12 HM 14 HM 15 HM 16

1. 2: Improved or remained independent in mid-loss ADL (ADL05) 24.70 18.34 21.25 15.63 8.26 30.89 3.90 23.08 35.35 36.67 24.11 15.15 29.51 13.04 7.48 7.98 3.72

2. 3: Improved or remained independent in early-loss ADL (ADL06) 14.10 9.57 2.50 18.75 9.17 21.14 3.90 11.54 19.19 15.83 8.04 18.18 3.28 7.73 1.87 5.52 0.41

3. 4: Improved late-loss ADL (ADL1A) 9.30 8.41 1.33 7.87 8.26 20.52 1.30 3.85 14.94 23.00 6.36 13.64 5.03 9.33 6.60 2.48 0.83

4. 9: Improved locomotion (MOB1A) 12.10 6.99 6.15 11.81 1.83 16.75 2.67 13.33 9.38 2.44 4.82 4.55 10.94 7.91 0.99 3.73 2.90

5. 11: Improved behavioural symptoms (BEHI4) 13.40 10.75 10.71 17.16 25.86 22.00 14.10 6.74 6.54 9.84 8.93 14.44 7.07 5.53 2.54 4.29 6.48

6. 13: Improved cognitive ability (COG1A) 4.20 2.97 2.74 2.40 1.01 15.45 2.67 0.00 0.00 1.68 2.68 3.03 1.14 0.00 0.95 1.27 0.00

2

QI Province Corp. HM 01 HM 02 HM 03 HM 04 HM 05 HM 06 HM 07 HM 08 HM 09 HM 10 HM 11 HM 12 HM 14 HM 15 HM 16

7. 15: Improved communication ability (COM1A) 5.80 5.55 0.00 12.12 0.00 31.52 3.70 0.00 0.00 2.00 1.35 10.00 1.53 0.00 1.12 1.01 0.00

8. 30: Improved bowel continence (CNT2A) 15.70 11.04 12.20 26.53 28.40 17.75 0.00 5.56 20.75 7.89 4.84 18.18 6.56 4.05 8.93 2.75 4.06

9. 31: Improved bladder continence (CNT3A) 9.00 7.26 6.00 7.77 10.75 20.11 0.00 9.26 7.89 7.46 3.88 13.04 6.16 7.04 2.86 2.36 1.81

1. 1: Worsened late-loss ADL (ADL01) 16.10 13.69 6.67 18.55 10.11 25.37 1.37 17.95 16.67 33.33 4.59 15.63 13.33 12.82 9.62 6.02 7.69

2. 5: Worsened or remained dependent in mid-loss ADL (ADL5A) 36.80 32.72 26.25 33.59 43.12 50.41 29.87 33.33 21.21 35.83 25.00 36.36 21.86 18.84 28.97 44.79 31.82

3. 6: Worsened or remained dependent in early-loss ADL (ADL6A) 27.50 29.40 12.50 28.91 45.87 47.15 18.18 11.54 20.20 62.50 22.32 54.55 10.38 20.29 16.82 47.85 18.18

4. 7: Worsened ADL (ADLD7) 33.40 26.77 16.25 36.72 23.85 38.21 9.09 42.31 27.27 35.83 16.96 34.85 29.51 23.67 20.56 18.40 21.90

5. 8: Worsened locomotion (MOB01) 18.40 14.62 18.42 32.93 14.29 34.65 6.78 20.41 8.24 13.98 9.09 2.50 12.03 7.41 11.90 15.07 9.15

6. 10: Worsened behavioural symptoms (BEHD4) 13.40 8.43 10.71 8.96 10.34 15.20 6.41 5.62 7.48 9.84 13.39 10.00 6.52 4.61 5.08 4.91 6.88

7. 12: Worsened cognitive ability (COG01) 9.60 7.75 12.33 12.30 6.25 27.04 2.67 0.00 5.32 12.26 3.74 6.25 3.35 0.53 7.77 3.55 5.33

8. 14: Worsened communication ability (COM01) 8.50 8.08 18.57 7.20 4.72 27.16 2.67 3.85 2.04 13.04 5.50 14.06 5.00 0.00 7.07 4.00 2.64

9. 17: Worsened mood from symptoms of depression (MOD4A) 24.50 16.30 20.24 15.67 21.55 21.20 17.95 17.98 19.63 19.67 26.79 40.00 13.59 11.11 9.32 8.59 5.26

10. 22: Worsened stage 2 to 4 pressure ulcer (PRU06) 3.30 3.06 3.57 2.26 2.63 5.74 7.69 1.14 2.80 1.64 1.79 5.56 1.63 3.81 0.00 3.11 2.42

11. 25: Worsened/unchanged respiratory condition (RSPX2) 8.10 9.33 14.29 5.97 8.62 3.20 7.69 7.87 8.41 4.10 2.68 0.00 14.67 7.37 8.47 4.91 27.42

12. 27: Worsened bowel continence (CNT02) 21.20 13.81 11.29 22.31 30.23 34.08 10.71 4.76 12.50 11.11 10.20 12.50 11.88 1.16 9.78 13.27 6.53

13. 28: Worsened bladder continence (CNT03) 17.90 11.14 13.56 10.57 12.86 24.26 10.64 2.27 2.17 16.84 8.05 10.00 10.46 2.50 4.65 16.81 11.17

14. 34: Worsened pain (PAN01) 10.60 7.55 7.14 3.73 25.66 7.26 10.39 6.82 7.48 4.96 11.82 9.09 4.97 0.92 9.32 6.88 7.26

1. 16: Has symptoms of delirium (DEL0X) 17.00 7.64 8.75 3.13 0.00 10.16 16.88 0.00 10.10 3.33 6.25 3.03 14.21 10.14 4.67 6.13 8.26

2. 18: Has taken antipsychotics no diagnosis of psychosis (DRG01) 23.90 20.93 50.67 22.61 21.36 20.43 24.19 22.06 18.56 23.16 16.98 26.42 20.81 18.50 9.90 18.00 18.91

3. 19: Has fallen (FAL02) 14.50 13.85 12.94 14.18 25.00 14.00 16.67 11.24 7.14 10.66 4.46 10.00 22.83 15.14 11.86 10.43 14.29

4. 20: Has one or more infections (INF0X) 10.70 9.12 17.50 10.94 9.17 6.50 12.99 10.26 12.62 8.33 15.18 3.03 9.29 10.10 1.87 8.59 6.95

5. 21: Has a stage 2 to 4 pressure ulcer (PRU05) 5.60 5.70 10.59 5.22 5.17 7.27 12.82 4.49 5.36 2.46 1.79 10.00 2.17 10.09 1.69 6.75 3.01

6. 23: Has a new stage 2 to 4 pressure ulcer (PRU09) 3.10 2.99 3.90 2.33 2.73 5.49 8.11 1.20 2.94 1.67 1.83 6.17 1.68 3.05 0.00 3.25 2.06

7. 24: Has daily physical restraints (RES01) 6.40 10.46 24.71 14.93 16.38 15.32 17.95 14.61 5.36 10.66 0.00 6.67 15.76 2.33 0.00 11.66 7.55

8. 26: Has an indwelling catheter (CAT02) 3.30 4.27 8.75 5.47 3.67 7.72 6.49 7.69 1.94 2.50 0.00 3.03 2.73 4.81 4.67 4.91 1.54

3

QI Province Corp. HM 01 HM 02 HM 03 HM 04 HM 05 HM 06 HM 07 HM 08 HM 09 HM 10 HM 11 HM 12 HM 14 HM 15 HM 16

9. 29: Has urinary tract infection (CNT04) 5.10 5.10 10.00 7.81 5.50 4.47 11.69 5.13 6.80 6.67 5.36 0.00 3.28 2.88 1.87 6.75 3.86

10. 32: Has a feeding tube (NUT01) 1.10 0.74 0.00 0.00 0.00 0.00 0.00 0.00 1.94 0.00 0.00 0.00 0.00 1.92 1.87 0.00 2.70

11. 33: Has pain (PAI0X) 6.30 3.93 0.00 0.75 7.76 5.20 3.85 1.12 6.25 1.64 10.71 4.44 3.26 2.29 2.54 7.36 2.26

12. 35: Has had weight loss (WGT01) 7.00 6.84 4.55 1.39 10.13 7.59 10.34 6.15 2.00 4.17 5.49 2.27 9.29 5.17 9.78 7.74 8.11

Graphical Display with Capability to Drill Down from Province to Region, to Home to Nursing Unit

4

The grouping of the results by home is defined by the user. For the example see Figure 9. The 35 QIs are organized by Improvement, Worsened. Or

Figure 9Grapical Display of 35 QIs Compared to Province

5

Negative Outcomes Shown are the results of each indicators result for the Enterprise (Dark Blue) compared to the average for all care homes in the

Province (Light Blue). By clicking on any of the QIS a drill down option will appear. For example Antipsychotic use

By clicking on the QI for Antipsychotic use the Enterprise result are shown. Then clicking on the Enterprise brings up the results for the next grouping in this

case Region. Clicking on a given Region will display the Antipsychotic use by Home and then by selecting a particular Home will display the results by

Nursing Unit. This allows the user to quickly identify where a concern may exist and quickly drill into the exact organizational unit. In this example we have

5 health regions and 18 homes with as many as 2 to 5 nursing units per home (See Figure 10).

6

Figure 10 All results by Enterprise, Region, Care Home and Nursing Unit

Top 3 Homes with Care Concerns by QI Figure 11 displays the top 3 homes where there is potentially a care concern. Continuing with the Antipsychotic QI it is seen that Care Homes 1, 6 and 11

have the highest occurrences of “Antipsychotic Use in the Absence of a Related Psychotic Condition”. The drop down box at the top left of the screen

allows the user to select the Top 2 or Top 1 indicators. Notice that the “Improvement Indicators” are labelled as the Bottom 3 because these homes have

the lowest level for improvement in functioning.

7

Figure 11 Top 3 Care Homes with Care Concerns for Each QI

8

Trending Quality over Time

In order to understand if a program to improve care is having a positive effect, it is important to be able to see the change in the percentage of occurrences

over time (See Figure 12). In the example below we have select once again the QI for Antipsychotic Use .

Figure 12 Trend in Quality Changes by Year or Quarter

9

It was selected from the drop down list in Box . Notice also we have chosen to only add the Province, Enterprise, Home 2, Home 3 and Home 4 to the

results. Homes can be added or removed by clicking on any of the circles at . On the horizontal axis is diplayed each of the reporting quarters included

in the report in this example for the year 2013 quarter 2 to 2015 quarter 3. The number of quarters displayed is controlled by the user by adjusting the bars

at . Looking at items the percentage of occurrence and focusing on the care home with the Green Line at (Home 03) one can see that Home 3

was experiencing an Antipsychotic utilization rate of 31% at 2013 Quarter 3 close to the Provincial average. However by 2015 quarter 2 the rate had risen

while the Provincial rate had dropped. However by 2015 Quarter 3 they had recovered their former position in 2013.

10

Medication Outcomes As part of the of MED e-care’s ongoing commitment to bringing better intelligence and evidenced based practice MED e-care will continue to expand its

capability in the Enterprise reporting domain. With the advent of new web based technologies any information that is captured by your system can be

easily displayed in any customized format. For example if the home is making use of the MED e-care Medication Ordering and Administration system or the

Treatment Ordering and Administration system, then these outcomes can be added to the Enterprise Reporting in the same way and detail found in the 35

Quality Indicators described above.

Key Performance Measure Medications Averages All Region H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16 H17

1: Average Number of Late Medication Administration 16.40 16.36 15.07 11.11 26.56 9.49 5.88 3.33 4.76 26.00 31.48 5.66 15.15 12.50 28.28 6.73 28.07 20.41 14.29

2: Average Number of Out of Stock Orders 25.10 17.44 28.38 7.55 26.00 13.33 0.00 16.13 35.71 39.22 28.33 20.00 12.12 32.38 8.49 1.77 10.34 7.84 8.54

3: Average Number of Expired Orders 14.50 11.92 21.62 1.89 32.67 4.67 2.78 0.00 19.05 37.25 20.00 9.09 12.12 7.62 6.60 0.00 3.45 3.92 9.76

4:Average Number of Minutes to Complete a Round 126 115 116 118 119 124 100 110 95 75 100 120 110 109 106 114 110 112 100

5: Average Number of Rejected Orders Due to Dispensing Errors 37.10 34.08 20.27 39.62 53.33 32.67 27.78 19.35 23.81 35.29 40.00 25.45 39.39 19.05 39.62 27.43 36.21 27.45 46.34

6: Average Number of Not Administered Medications 28.20 27.04 24.32 41.51 38.67 21.33 19.44 9.68 11.90 13.73 58.33 18.18 63.64 4.76 25.47 14.16 29.31 15.69 57.32

7: Average Number of Medication Refusals 33.80 29.52 29.73 24.53 37.33 23.33 11.11 12.90 23.81 35.29 36.67 21.82 39.39 27.62 49.06 14.16 44.83 29.41 26.83

8: Average Number of PRNs 18.60 16.75 14.89 15.38 30.38 12.62 0.00 17.65 27.78 22.73 16.67 14.81 14.29 14.67 23.53 9.88 17.39 12.50 11.76

9: Percent of PRNs not Administered by Round 12.20 7.68 22.22 5.66 14.16 1.75 0.00 0.00 20.00 17.24 30.00 6.98 6.06 9.33 2.53 0.90 5.66 4.17 4.94

10: Average Number of Wasted Medications over 24 Hours 13.60 11.45 12.66 22.81 19.21 16.45 5.56 21.88 6.67 14.55 8.33 7.14 2.44 5.66 11.93 9.65 10.77 0.00 4.88

11: Average Number of Destroyed Medications over Month 13.70 10.05 13.92 24.56 13.91 5.92 11.11 15.63 2.22 14.55 13.33 16.07 17.07 6.60 6.42 4.39 4.62 9.43 7.32

12: Percentage of Residents using Antipsychotics 9.70 8.57 6.85 12.77 25.83 6.72 11.43 13.79 2.78 4.00 14.55 5.77 6.25 5.83 4.08 2.83 5.45 0.00 10.29

11

13: Percentage of Residents prescribed Anticoagulants 4.50 4.57 10.00 4.17 22.30 0.00 0.00 3.70 5.00 3.92 1.67 0.00 6.06 0.00 1.96 0.00 0.00 1.96 2.56

14: Percentage of Residents prescribed Diabetic Medications 8.70 7.55 4.05 11.54 26.24 6.47 8.57 10.34 7.32 5.88 8.77 3.70 6.25 1.94 2.04 2.88 0.00 2.08 7.89

12

Relative Resourcing Model Based on Clinical Assessment The trending of actual and expected resource requirements is an important aspect of ensuring that a care home is able to provide the level of care needed

in their home. MED e-care provides a mechanism that allows the user to display the direction of funding over time. The interRAI RUG III model contains a

method of calculating relative resource requirements or a Case Mix Index (CMI). As with the RAI 35 Quality Indicators CMI results can be displayed by year

or Quarter . In addition one is able to display the provincial CMI, enterprise average CMI and any or all care homes CMI . The user is also able to

customize the time period over which the CMI level is displayed .

Figure 13 Relative Resource Requirements