LTC Applied Research Education Day 2010

 Quality of Care

RECEIVED THE 2010 RESIDENTS' CHOICE POSTER AWARD
Innovation in Digital Storytelling Project: Resident Voice Part 2 “Quality of Life at the End of Life”
Gina De Souza, RN, BScN, Improvement Facilitator Lead, Ontario Health Quality Council, Gina.DeSouza@ohqc.ca

• To demonstrate how using an innovative approach of Digital Storytelling to focus on resident experience, can impact staff learning and promote resident centred care in Long Term Care homes.
• To re-awaken and re-inspire compassionate caring in the LTC community by stimulating reflection of the importance of understand the lived experiences, values, beliefs and preferences of residents in LTC homes.
• To explore the impact that these resident experience stories may have on other residents living in Long Term Care Homes.

Promoting Continence in LTC
Daniela Cahuas, EdD(c), MScN, GNC(C), NCA, ET, Consultant, Main Street Terrace Daniela.Cahuas@reveraliving.com

In an effort to improve practices and promote continence the Versa Care Nursing Home has instituted a comprehensive continence program. The introduction of the Continence Management Program has been highly effective in providing dignified, comfortable care thus meeting the complex needs of the residents. The program has established in the facility a culture which supports and nourishes nursing evidence based practice by: ensuring adherence to standards and procedures for continence care; building the support and networks necessary to augment learning and improving practice related to continence care. Beside the introduction of new tools and policies, the education component was pivotal in supporting the development and rollout of this program. Education was provided on a continuous basis and in the form of large forums, workshops, quizzes, information sessions, fact-finding format, and just-in time teaching-learning in-services.

A Practical Approach to Improving Continence Care in Long Term Care (LTC)
Heather Woodbeck, RN, HBScN, MHSA, Best Practice Coordinator for Long Term Care, Northwestern Ontario, Registered Nurses’ Association of Ontario. (RNAO), woodbech@tbh.net

The Improving Continence Care Collaborative (IC3) is a Quality Improvement Initiative, the purpose of which is to improve life for LTC residents by improving their continence care. Since 2006, over 50 LTC homes from across Ontario have come together to learn about and share effective approaches for continence improvement.  For the past 3 years, LTC homes have met virtually via the Ontario Telemedicine Network’s (OTN) videoconferencing system.  The IC3 Community of Practice is funded by the Seniors Health Research Transfer Network (SHRTN).  The initiative used the Breakthrough Series Method of Improvement to help homes set an aim, monitor the impact and implement best practices in bowel and continence care.  Homes have made marked changes to improving the lives of those who both live and work in LTC in Ontario.  These improvements were made possible by the time and team commitment of the LTC Home front-line staff; and with committed Collaborative leaders who have worked tirelessly to effect and sustain changes.

Decreasing  Hospital Visits of Long Term Care Residents Using a Pneumonia Protocol
Darlene Harrison, RN HBScN, Resource Consultant, Centre for Education and Research on Aging and Health, daharris@lakeheadu.ca

Funded  by the Ministry of Health and Long Term Care through HealthForce Ontario, “Building Capacity for Interprofessional Collaborative Care In Long Term Care” or the“ Bridges to Care Project” was a knowledge to practice initiative aimed to facilitate improvements in resident outcomes.  Initiated by the Centre for Studies in Aging & Health, Providence Care, Kingston, the project included three pilot sites; Kingston, Ottawa and Thunder Bay.  In Thunder Bay, the Centre for Education and Research on Aging and Health (CERAH) partnered with Pinewood Court, Reveraliving Long Term Care. The Thunder Bay project focused on the early identification and management of pneumonia to prevent emergency room visits and a possible hospital admission.  Pneumonia is a major reason for hospitalization of long term care residents.  Hospitalization can have deleterious effects on older adults from the onset of delirium to rapid loss of remaining skills and abilities. The aim was to minimize the hospitalization of residents with pneumonia to 30% of all diagnosed cases.

Supporting Quality Pain and Symptom Management in Long Term Care
Mickey Turner, Palliative Care Consultant, Palliative Care Consultation Program, mturner@acclaimhealth.ca

In 2007, the Palliative Pain and Symptom Management Consultants in Halton & Peel implemented an innovative approach across various regions to increase the capacity of individuals, teams and organizations to provide exemplary pain management within Long Term Care Homes.  Utilizing concepts from the CHPCA manual, A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice, (March 2002), the goals were to improve the confidence and capacity of nursing staff in managing pain and other palliative care symptoms, encourage use of evidence to support their practice and to enhance communication among the interdisciplinary team using a case based approach.

Improving Measures of Prescribing Quality in Long-Term Care Homes Using a Structured Panel Process
Stacey Brener, MSc. candidate Health Services Research, Research Coordinator, St. Michael's Hospital, breners@smh.ca

Background: Employing appropriate health quality indicators helps support improvement efforts. Quality indicators that evaluate continuity of care between acute and long-term care facilities, specifically the unintentional discontinuation of medications for chronic diseases, have not been described.  This study was designed to develop quality indicators related to the potential unintentional discontinuation of medications for chronic diseases when patients return to long-term care (LTC) from acute-care facilities.  A modified Delphi panel was convened to develop new quality indicators that were effective, relevant, and feasible with currently available administrative data. The panel was comprised of 10 experts with broad geographic and clinical representation.  Panel members anonymously completed a survey prior to the in-person discussion. The panel meeting refined the parameters regarding the proposed quality indicators. A final anonymous survey then assessed for consensus among panel members.

Enhancing Measures of The Quality of Benzodiazepine Prescribing in Long-Term Care Homes Using a Structured Panel Process
Susan Bronskill, Scientist, Institute for Clinical Evaluative Sciences, susan.bronskill@ices.on.ca

The goal of this project was to prioritize the importance of existing indicators of the quality of  benzodiazepine prescribing in LTC homes and to incorporate processes of care (based on transition points and specific clinical conditions) which might influence measurement. We convened a modified Delphi panel to appraise the existing quality indicators related to benzodiazepine prescribing that were currently feasible with available administrative data. The panel was comprised of 10 experts with broad geographic and clinical representation.  Panel members anonymously completed a survey prior to an in‐person discussion. Discussion during the panel meeting refined the proposed quality indicators. A final anonymous survey then assessed consensus among panel members.

Assessing Current Patterns of Psychotropic Drug Use for the Treatment Of Behavioural and Psychological Symptoms Of Dementia in a Long Term Care Setting
Carlos Rojas-Fernandez, BSc(Pharm), PharmD, Schlegel Research Chair in Geriatric Pharmacotherapy, Schlegel-UW Research Institute on Aging & School of Pharmacy, University of Waterloo, carlos.rojas-fernandez@uwaterloo.ca

The majority of patients with dementia will eventually suffer from one or more behavioural and psychological symptoms of dementia (BSPD).  Non-pharmacological approaches to managing BPSD are often preferable, but it is often necessary to utilise psychotropic medications to manage these symptoms.  Prudent use of these medications mandates that the ongoing need for their use be assessed after a period of time (e.g., 3 months) given their limited overall efficacy and potential for adverse drug events. It is equally important that these medications are optimised with regards to choice of medication, medication dose, and ongoing assessment of safety, as these factors will affect the quality of life of patients who receive these drugs.  It is thus of significant clinical importance to understand how these medications are being utilised in order to develop appropriate initiatives to maintain and enhance the care of seniors, with the ultimate goal of improving their quality of life.

RECEIVED THE 2010 DELEGATES' CHOICE POSTER AWARD
Preventing Hip Fractures In LTC through Screening Protocols and Innovation
Candace Chartier, Registered Nurse, Chief Operating Officer, OMNI Health Care, cchartier@omniway.ca

Osteoporosis and fractures cost the health care system in excess of $1.3 billion dollars each year and in fact over 80% of all fractures in people over the age of 60 are Osteoporosis related. In a 2007 study it is estimated that a hip fracture in long term care costs $38,000 of health care costs and there is a 20% chance of mortality in the first 12 months following a hip fracture. As well, 1 out of every 5-6 people over the age of 75 are diagnosed with Diabetes with a prevalence of approximately 45% of our 1466 residents being diagnosed with Diabetes. OMNI Health care has created a policy program through our 17 sites consisting of the following;  -Osteoporosis Screening Tool and Policy to determine Risk  -Policy on the use of Therapuetic Far Infra Red Technology Hip Protectors  -OMNI Diabetes Screening Protocol and Screening program to determine appropriate diabetic medication and insulin regime  -BEERs List Screening Program  -Innovative education system to deliver education to our staff, families and residents 24/7 on site.

Falling Forward: Analyzing Fall Data at Belmont House
Stacey Brener, MSc. candidate Health Services Research, Research Coordinator, St. Michael's Hospital, breners@smh.ca

Falls are one of the leading causes of injury and complications faced by seniors (>65yrs) in long-term care homes in Ontario. The Institute of Clinical Evaluative Sciences has determined that 9 in 100 residents experience a fall severe enough to warrant ambulance transportation to hospital a year.  Belmont House, a home for the aged situated in the heart of Toronto, has one of the highest fall rates in the region. As a result, an analysis of fall incident reports was undertaken by Quality Improvement team 6 of the IHI Open School, University of Toronto chapter, under the supervision of Karen Yatabe, RN. This study was designed to identify trends and common contributing factors in resident falls at Belmont House LTC home from December 2009 to February 2010.

Bridges to Care: Linking People, Ideas and Resources in Long Term Care, Preliminary Phase and Workshop 1; Building Capacity for Interprofessional Collaborative Care in Long-Term Care: Action Phases, Workshop 2 and Sustainability
Rosemary Brander, PhD(c), MSc, BSc(PT), Senior Researcher and Program Evaluator, Centre for Studies in Aging & Health, Providence Care and Queen's University, branderr@providencecare.ca

Funded by the Ministry of Health and Long Term Care-HealthForceOntario, this project enhanced quality care for residents in six Ontario Long Term Care Homes by facilitating knowledge-to-practice transfer in common care issues (falls, nosocomial infections and responsive behaviours in dementia) and engaged Homes in Quality Improvement (QI) methodology to positively support directed change. Workshop 1 and Workshop 2

Breaking KTE Barriers with the Alzheimer Knowledge Exchange 
Megan Harris, KTE Associate, Alzheimer Knowledge Exchange, meganharris@sympatico.ca

A major challenge for both paid and non-paid care partners of individuals with dementia is timely access to relevant research-based information, best care practices, and to the services, resources and supports provided by various government and community agencies and organizations.  Engaging these care providers in knowledge translation and exchange (KTE), through networks, can facilitate the flow and use of meaningful information, to support evidence-informed decision making and better care for people with dementia.

In Ontario, the Alzheimer Knowledge Exchange (AKE) promotes and supports a knowledge translation and exchange (KTE) interface amongst researchers, educators, care partners (paid and non-paid), policy makers and stakeholder organizations.   The AKE connects all sectors, settings, and disciplines, in order to support the learning needs of people seeking practice change.

Food and Nutrition

Menu Planning in Long-Term Care: Towards Resident-Centred Menus
Kate Ducak, BA (Hons. Gerontology), Graduate Student, Health, Aging & Society, McMaster University, kducak@mcmaster.ca

This study describes the factors that influence the menu planning process in Ontario long-term care (LTC) homes and the perspectives of key informants on how it could be improved to promote resident-centred menus.  Key informants were interviewed via telephone to obtain qualitative data using standardized open-ended questions.  The key informants (n=35) were randomly selected Nutrition Managers of Ontario LTC homes.  Selected Registered Dietitians from the Ontario Long-Term Care Action Group also participated (n=5).  Descriptive thematic analysis was completed on data provided.  Three overarching themes emerged from the data as drivers in the menu planning process: resource limitations, Ministry standards, and accommodating diverse and evolving preferences.  Challenges involving resources include insufficient food labour and raw food funding, the workload involved with altering menus, and providing special food items for special diets or preferences.  Regarding Ministry standards, participants reported barriers to complying with rotation and portion standards.  Other common obstacles within LTC homes include accommodating personal preferences, cultural preferences, and therapeutic diets.  LTC homes in Ontario face numerous challenges when planning menus for residents regardless of the home’s size, location, or profit status.  Suggestions are presented with the aim of improving the menu planning process and providing high quality, palatable and culturally appropriate food in these homes so that menus are resident-centred.

Applied Research and Recipe Development at George Brown College: Benefits to Long Term Care Sector
Winnie Chiu, George Brown College, wchiu@georgebrown.ca

The Centre for Hospitality and Culinary Arts (CHCA) of George Brown College develops innovation form internal and external initiatives.  This paper provides relevant information on innovation and applied research CHCA and then focuses on four recently funded innovation/research projects:  Development of household baking recipes using a gluten-free flour blend; Recipe optimization and commercialization of health snacks; Building recipes and understanding nutrition for cancer-survivor health; Community nutrition teaching model for ethno-specific Diabetes education prevention.

Modified-Texture Food – Impact On Change In Weight Status and Food Intake Among Older Persons in a Time-Series Study Of Dysphagic Food Products
Helen Niezgoda, B.Sc.N., MSc., Nursing Research Manager, Élisabeth-Bruyère Research Institute, HNiezgoda@bruyere.org

Under nutrition is a significant problem among older adults (40-80%) whether they live in long-term homes or continuing care organizations, admitted to acute care or living in the community receiving meal assistance.   A nine month pilot study using a prospective interrupted time-series design, where participants served as their own controls, was conducted to investigate the effect of a new modified-texture food on the nutritional status (as measured by body weight and weight goals as determined by a clinical dietitian) of individuals requiring a modified-texture diet living in a continuing care facility. Proportion of food intake and the occurrence of clinically important morbidities including the number of falls, antibiotic use, and acute care hospital admissions were also investigated. This study provides data which will assist in the planning and development of a multi-center intervention study on modified-texture food.

Recommendations to Address Weight Loss in Two Long Term Care (LTC) Facilities
Susan Goldberg, RD, Clinical Dietitian, Compass Group Canada, c/o Vermont Square, O'Neill Centre, sgoldberg@responsive.on.ca

Unintentional weight (wt) loss in long term care residents is associated with an increase in hospitalization and mortality. Thus, Minimum Data Set (MDS) quality indicators indicative of poor clinical outcomes include wt loss data. We conducted a research project to determine the prevalence of wt loss in 2 LTC facilities, to compare to average Ontario rates of wt loss, to determine possible contributing factors to wt loss, and to develop a list of recommendations to address these identified contributing factors.

Hydration Recommendations: What is the Evidence?
Leslie Whittington-Carter, MHS, RD, whitcart@amtelecom.net

Dehydration and fluid overload are of great concern to health professionals working with the elderly population, yet a review of the literature shows lack of consensus on the definition of dehydration, and no strong evidence to support current methods of estimating optimal fluid intake.  Elderly persons are especially susceptible to shifts in fluid and electrolyte balance, leading to adverse health outcomes, making it essential that hydration recommendations are evidence-based. This paper reviews current literature on fluid needs of the elderly, and makes recommendations for future research.

25-Hydroxyvitamin D Levels Increase Progressively With Higher Vitamin D Doses in Elderly Long-Term Care Residents
Mary-Lou van der Horst, RN, BScN, MScN, MBA, SHRTN Project Manager/LTC Nursing Consultant, Osteoporosis Strategy for Long-Term Care, Hamilton Health Sciences, dhm9@xplornet.com

Residents living in long-term care (LTC) are at a greater risk of experiencing falls and fractures.  Meta-analyses suggest 25 hydroxyvitamin D (25-OHD) levels of ≥ 75 nmol/L to achieve fracture prevention.  Few studies have assessed the vitamin D status of LTC residents.  This study was designed to determine the level of vitamin D insufficiency in the elderly living LTC; and, to determine the relationship between vitamin D supplementation and 25-OHD levels.

Palliative End-of-Life Care

The Concept of Hope in Relation to End of Life Care
Janusz Kaleta, C.P.T.A., R.P.N., IIWCC, Staff Educator, Nursing, Cedarvale Terrace Long Term Care Home, jkaleta@responsive.on.ca

Palliative Care Residents are often confronted with incurable diseases and or end stage conditions that may carry significant psychological burden of acceptance.  This may lead in turn to additional complications such as depression and withdrawal.  The concept of Hope can have a powerful impact on communication strategy.  Famous Physician and Surgeon Dr. Bernie Siegel once said “We do not have a dying patient….the patient is either dead or alive and as long as she / he is alive there is always something we [clinicians] can do” further Dr. Siegel stated that “Refusal to hope is nothing more than a decision to die.  I know there are people alive today because I gave them hope” (Siegel 1988).      Palliative Care Conference held with resident, family and Interprofessional Team was formed to respond in a timely manner to changing needs of residents in order to effectively plan end of life care.  This approach involves resident (whenever able to participate), family, Social Worker, front line caregivers (PSW, HCA), and registered staff (RNs, RPNs), Physician, Physiotherapist, Activity personnel, Registered Dietitian.  The conference as well as interprofessional communication assures that wishes and needs or resident’s are properly taken into consideration and respected.  Recognition of what resident desires and needs are essential in installing hope and assisting in fulfillment of ones last wishes.

LTC Residents and Their Family’s Experiences and Perceptions of Palliative Care
Mary Lou Kelley, MSW, PhD, Professor, School of Social Work, Lakehead University, mlkelley@lakeheadu.ca

While long-term care (LTC) homes are a major location of death for people in Canada, formal palliative care programs in LTC homes that aim to relieve suffering and improve the quality of living and dying for residents are rare. A goal of a five year Community University Research Alliance funded by the Social Sciences and Humanities Research Council (SSHRC) entitled Improving the Quality of Life of People Dying in Long Term Care Home is to bring forth an increased awareness of palliative care philosophy to LTC residents and their families. The research is comparative case study design involving four Ontario LTC homes.  For an initial environmental assessment in each home, data were collected from residents, families, staff and community organizations regarding their understanding experiences and vision regarding palliative care using surveys, focus groups and interviews. Participatory action research methodologies are being applied to involve staff members, volunteers, families, residents and community organizations in the development, implementation and evaluation of a holistic palliative care programs based on the research evidence.  Involving residents and their families reflects the resident-centred philosophy that current LTC legislation embraces.

Spiritual Care Needs at End-of-Life
Rev. Peter Barnes, pbarnes555@gmail.com

Spiritual Care Needs at End-of-Life  This presentation discusses needs of the dying, and the components of a “good death”.  It delves into the causes of spiritual distress, and what the spiritual care practitioner or pastoral volunteer can do to help. 

The Nature of Occupation at End-of-Life
Anna Park Lala, MScOT, PhD Candidate, Health & Rehabilitation Sciences, Field of Occupational Science, The University of Western Ontario, apark27@uwo.ca

According to the Canadian Association of Occupational Therapists [CAOT] (2008), every Canadian is entitled the right to a quality end-of-life experience. Human occupation is a basic human need, and has the potential to facilitate meaningful day-to-day experiences (Wilcock, 2006). However, it is uncertain whether the occupational needs of people at end-of-life are being met. The limited ability to participate in activities that make life enjoyable has been consistently cited as a reason terminally ill individuals request lethal medication to hasten their death (Oregon Department of Human Services, 2006, 2007, 2008).  There is potential that everyday occupations, both ordinary and extraordinary, can contribute to good dying experiences (Davel Jacques & Hasselkus, 2004).  The purpose of this phenomenological study is to examine the embodied nature of occupation at end-of-life, from the perspectives of Canadians 60 years of age or older, and living with a terminal illness.

Standards for Service Delivery: Achieving Excellence in Hospice Palliative and End-of-Life Care
Toby Yan, Accreditation Specialist, Accreditation Canada, Toby.Yan@accreditation.ca

In June 2000, a subcommittee of the Standing Senate Committee on Social Affairs, Science and Technology tabled its report “Quality End-of-Life Care: The Right of Every Canadian”. The subcommittee recognized a gap in the provision of end-of life care and recommended that a national strategy for palliative and end-of-life be developed. This national strategy was coordinated by Health Canada’s Secretariat on Palliative and End of Life Care. As part of the Working Group on Best Practice and Quality Care, Accreditation Canada undertook a project to strengthen the quality of services delivered in the field.

"They Don’t Just Disappear”: Acknowledging Death in the Long-Term Care Setting
Janine Maitland, Senior Research Director, St. Joseph's Health System Research Network, jmaitlan@sjhcg.ca
 
In the Long-Term Care (LTC) setting, death is experienced frequently by residents and staff. In the community, bereavement rituals provide opportunities to express grief, share the sense of loss, and support bereaved individuals. However, in LTC, logistical considerations inhibit the ability of residents and staff to share in these support rituals. An additional concern relates to the short time frame in which the deceased is replaced with a new resident complicating the grief felt.  There is little literature examining the impact of dealing with frequent deaths in LTC and of current practices for coping with grief.  A Room Blessing Ritual is practiced at St. Joseph’s Health Centre Guelph to acknowledge and support residents and staff when a resident dies. Prayers are said and memories are shared in honour of the deceased. Prayers are also said for the new resident who will occupy the room.  A qualitative study was conducted to (a) document the value of the Room Blessing from the perspective of residents, family members, and staff, (b) extend current practice and research about bereavement rituals to support those living and working in LTC, and (c) inform quality improvement initiatives to enhance the ritual experience for future Room Blessing participants.

Policy and Funding

Promoting the Awareness of Elder Abuse in Long-Term Care Homes
Heather McConnell, Associate Director of the International Affairs & Best Practice Guidelines Program, Registered Nurses’ Association of Ontario, hmcconnell@RNAO.org

The Canadian Nurses Association (CNA) has partnered with the Registered Nurses’ Association of Ontario (RNAO), with funding provided by the Government of Canada's New Horizons For Seniors Program, to increase front-line service providers’ awareness and understanding of elder abuse in long-term care homes.  The activities of the Promoting Awareness of Elder Abuse in Long-Term Care Homes project are to (1) develop and deliver education sessions on elder abuse prevention customized to long-term care sites across Canada; (2) develop promotional material on elder abuse prevention; and (3) develop an online elder abuse awareness toolkit.  The Promoting Awareness of Elder Abuse in Long-Term Care Homes project will utilize a multi-prong intervention strategy to implement this project:

1. Identification and compilation of elder abuse awareness resources
2. Five long-term care (LTC) Prevention of Elder Abuse Centres of Excellence (PEACE) sites, representing a range of jurisdictions
3. Five RN LTC elder abuse awareness coordinators
4. LTC champions in a range of long-term care homes
5. Evidence based education on prevention of elder abuse
6. Pan-Canadian dissemination of resources across sectors

RECEIVED THE 2010 BEST STUDENT POSTER AWARD
How Residents in Long Term Care Facilities in Canada Rate their Quality of Life?
Vahe Kehyayan, PhD Candidate, Department of Health Studies & Gerontology, Aging, Health & Well-Being, Faculty of Applied Health Sciences, University of Waterloo, vkehyaya@uwaterloo.ca

This research study is part of a doctoral study on the “Relationships between Long Term Care Facility Residents’ Self-Reported Quality of Life and Resident and Facility Characteristics”.  This study was conducted because residents in long term care (LTC) facilities place a high value on quality of life (QoL). Quality of life matters, since for the majority of these individuals, the facility becomes their permanent home for the remainder of their lives. The study examines residents’ self-reported quality of life and explores contributory factors that may influence their perception of QoL.  Over 900 residents from 48 LTC facilities from several Canadian provinces participated in this study.

Emergency Department Transfers Following Transitions into Long-Term Care 
Andrea Gruneir, Ontario MOHLTC Career Scientist, Women's College Research Institute, andrea.gruneir@wchospital.ca

To date, there is relatively little research describing emergency department (ED) transfers from long-term care (LTC). However, available research and general consensus suggest that ED transfers are frequent events. Reducing the frequency of ED transfers has been highlighted as an area of primary concern by a number of stakeholder groups but doing so safely and in a way that will ensure that resident needs are properly addressed requires additional research to understand where there may be opportunities for intervention. Transitions have already been identified as a time when frail older residents are particularly vulnerable to adverse events. In this study, our objective was to quantify the occurrence of ED transfers among LTC residents based on recent health care transition. We focused on two types of transitions: 1) recent admission into the LTC facility, and 2) recent inpatient hospitalization.

Who is Placed in Long-Term Care in Ontario? An Examination of Wait Times and Resident Characteristics
Susan Bronskill, Scientist, Institute for Clinical Evaluative Sciences, susan.bronskill@ices.on.ca

Long-term care (LTC) homes in Ontario are designed for people who require the
availability of 24-hour nursing care and supervision within a secure setting. The
provincial government sets standards for care, inspects homes annually and sets
the rules governing eligibility through a centralized admission process which is
managed through regional waiting lists.  Recently the provincial government implemented a large-scale policy intervention (the Aging at Home Strategy) in part to help relieve pressure on these waiting lists. In order to be able to assess the Strategy’s impact on future waiting list patterns, an understanding of current and past waiting list trends is required.

The Canadian Staff Time & Resource Intensity Verification (CAN-STRIVE) Project: Evaluating Case Mix Systems in Nursing Homes and Complex Continuing Care
John P. Hirdes, Professor, Department of Health Studies and Gerontology, University of Waterloo,  Scientific Director, Homewood Research Institute, hirdes@uwaterloo.ca; xfwu@uwaterloo.ca

Case mix is a method of describing the relative resource utilization of clients using clinical characteristics.    It can be used to inform funding decision, staffing, risk adjustment, planning and program evaluation.   Fries et al., 1994, developed the case mix classification (resource utilization groups, RUG-III) based on the MDS 2.0 assessment for long term care (LTC) homes and complex continuing care (CCC) hospitals. In 2005, Dr. Fries led the STRIVE project, which validated RUG-III in the US.  Currently, case mix indices (CMIs) are being used in Ontario’s CCC hospitals, and are being phased in to LTC homes. These CMIs are based on US evidence with Canadian wage rates.  The CAN-STRIVE study is the first to evaluate the case mix system in a Canadian setting and calibrate RUG-III CMIs to Canadian practices.  Data were collected from 28 LTC homes and 25 CCC hospitals, following US STRIVE data collection protocols with only minor variations. Items collected included full MDS 2.0 assessment, CAN-STRIVE addendum, 24 hour STM data for nursing units, 7-day log STM data for non-nursing clinical staff, medication administration record, and 90 day discharge disposition.

A Framework for Performance Measurement and Improvement in Nursing Homes
Dina Franchi, MA, Doctoral Candidate, HPME, Univeristy of Toronto, dina.franchi@utoronto.ca 

There is increasing interest in measuring and improving performance in nursing homes. The predominant approach is to infer performance using a collection of loosely connected structural, process or outcome measures. These measures are often based on available indicators and are absent of a conceptual framework that defines domains of performance that enable system-level improvements.   The purpose of the study is to present a conceptual framework that includes clinical and non-clinical factors that affect performance in nursing homes from a system-level improvement perspective.