QI Program progress stalls: Trends revealed in annual report

Despite early gains in key areas, the Quality Indicator Program 2023/24 annual report shows that some critical outcomes – including the use of physical restraint – have increased over the past 12 months.

Elsewhere, workforce retention is trending in the right direction, while aged care residents are reporting a better quality of life.

Key points

• The QI Program collects quality indicator data from residential aged care services (RACS) every three months
• It currently includes 11 indicators: pressure injuries, use of physical restraint, unplanned weight loss, falls and major injury, medication management, activities of daily living, incontinence care, hospitalisations, workforce, consumer experience and quality of life
• The latest annual report covers the four quarters of 2023-24 with QI Program data from Quarter 4 of 2022-23 also included as it was the first time certain quality indicators were recorded
• There was little variation in the QIs across the five quarters in the annual report, although long-term comparisons show statistically significant decreases in unplanned weight loss, antipsychotic medication use and use of physical restraint
• Differences in QI performance were observed across states, territories, and remote areas, with no consistent patterns

Early gains lose ground

One of the most positive findings from the QI Program is that the indicators included since its inception have all seen significant decreases in the percentage of care recipients reported.

For example, the rate of polypharmacy has decreased from 40.6% of residents to 34.3%. Other notable trends include the use of physical restraint decreasing by 4.2 percentage points and antipsychotic medication use dropping by 3.5 percentage points. 

The percentage of care recipients who reported a fall has increased marginally from 2021, moving from 32% to 32.6%. 

This slight increase is representative of short-term trends that have either seen certain results stagnate or rise despite early decreases.

While polypharmacy has decreased since 2021, it stalled throughout 2023-24. Antipsychotic use, physical restraint exclusively through the use of a secure area and falls all increased during the same period but are still lower than the 2021 totals.

Fluctuations for both weight loss categories and a rise in physical restraint are more concerning. The percentage of residents with either significant or consecutive unplanned weight loss has bounced between 7.1% and 9.4% over the past year. Physical restraint also increased in the 12-month period.

Others have shown strong consistency to indicate they potentially sit at a natural baseline. One of the clearest examples is falls that resulted in major injury. This QI was 1.8% at the end of 2023-24 compared to 2.1% in 2021. 

New indicators show promise

Elsewhere, newer quality indicators are showing positive results across the board.

Workforce, which measures the percentage of care staff who stopped working for a provider between quarters, has decreased from 6.8% to 5.1%. Retention has dramatically improved amongst registered nurses/nurse practitioners, enrolled nurses and personal care staff/assistants in nursing with Quarter 4 results the strongest of all.

Consumer experience and quality of life are also up with both measuring the proportion of care recipients who reported ‘good’ or ‘excellent’. Consumer experience improved by 2.8 percentage points and quality of life by four percentage points. 

The only major trend to move in the wrong direction was hospitalisations. Emergency department presentations and hospital admissions hit a 12-month high in Quarter 4. 

Data collection concerns

The annual report’s author, the Australian Institute of Health and Welfare (AIHW) acknowledged that it is not the primary collector of QI data and that any observations are based on its analysis of data submitted by aged care providers to the Department of Health and Aged Care. 

However, it did suggest there are concerns over the quality of data provided by some residential aged care providers. Most issues relate to extreme upper-level ‘outliers’ and the extent of zero reporting. 

“Some services included in this report had questionable discrepancies in the total number of care recipients assessed for inclusion in each QI,” the report stated. 

“While some variation in the total number of care recipients assessed in a RACS can be expected given that measurements for different QIs can occur at different times, the magnitude of this variation for some RACS may be indicative of potential data entry errors or misinterpretation of the Manual or reporting template.

“Some inconsistencies were observed regarding how QIs (e.g. incontinence associated dermatitis (IAD)) and their additional reporting categories (e.g. IAD sub-categories) were recorded.

By definition, data for QI totals (e.g. IAD total) are inclusive of any additional reporting data (e.g. IAD sub-categories), but some services reported higher counts for additional reporting categories than for the corresponding total QI.”

AIHW said it will continue to consult with the department to ensure improved quality of reporting occurs. 

Residential Aged Care Quality Indicators Annual Report 2023-24 can be viewed here.