Table 2 Description of Home Care Quality Indicators including Stratification and Adjustment Covariates

ADL improvement^a

Clients with baseline impairment and a better score on the ADL long form.

Stratification: IADL capacity scale score

Adjusted for: not independent cognition, ADL decline, clinical risk, falls, hospitalizations, ADL hierarchy scale score

ADL decline^a

Clients with a score of less than 18 on the baseline ADL long form who decline further.

Stratification: IADL summary scale

Adjusted for: difficulty with meal preparation, housework and bathing, unsteady gait, Cognitive Performance Scale score, institutional risk, ADL hierarchy scale score

Bladder decline^a

Clients who experienced a decline in bladder continence (baseline score is less than 5 and lower than follow-up score). Includes clients who developed a new bladder continence problem.

Stratification: IADL performance scale

Adjusted for: difficulty with meal preparation, clinical risk, ADL hierarchy scale score, age over 80 years

Bladder improvement^a

Clients who experienced an improvement in bladder continence (baseline score greater than 0 and greater than follow-up score).

Stratification: ADL hierarchy scale score

Adjusted for: not independent cognition, sadness, difficulty bathing, ADL decline, hospitalizations, institutional risk

Cognitive improvement^a

Clients with some baseline cognitive impairment on the Cognitive Performance Scale who experience an improvement.

Stratification: IADL summary scale

Adjusted for: difficulty with phone use, impaired decision making, Alzheimer’s diagnosis, clinical risk, not independent cognition, less than 2 h of activity daily, Cognitive Performance Scale score

Cognitive decline^a

Clients with a score of less than 6 on the Cognitive Performance Scale at baseline who experience a further decline. Includes clients who experience a new cognitive impairment.

Stratification: IADL performance scale

Adjusted for: difficulty with phone use, managing finances, meal preparation and bathing, falls

Communication improvement^a

Clients with some difficulty in the communication scale (problems understanding others or making themselves understood) at baseline who experience an improvement (lower score on the communication scale).

Stratification: IADL capacity scale

Adjusted for: dementia (both Alzheimer’s and non), clinical risk, sadness, Cognitive Performance Scale score, ADL hierarchy scale score, age over 80 years

Communication decline^a

Clients with a score of less than 8 on the communication scale at baseline who experience a decline (higher score on the communication scale). Includes clients with new difficulties in communication

Stratification: IADL performance scale

Adjusted for: difficulty managing finances, managing medications, and with phone use, Alzheimer’s disease, clinical risk, ADL hierarchy scale score

Falls

Clients who experienced one or more falls in the last 90 days.

Stratification: clinical risk

Adjusted for: use of assistive device, unsteady gait, ADL hierarchy scale, age over 80 years

IADL improvement^a

Clients with a score greater than 0 on the IADL self-performance summary scale at baseline who experience an improvement (lower score).

Stratification: clinical risk

Adjusted for: sadness, ADL decline

IADL decline^a

Clients with a score less than 15 on the IADL self-performance summary scale at baseline who declined (had a higher score).

Stratification: clinical risk

Adjusted for: difficulty with meal preparation and housework, institutional risk, ADL hierarchy scale score

Injuries^a

Clients with new injuries - fractures, second- or third-degree burns or unexplained injuries – since baseline.

Stratification: clinical risk

Adjusted for: ADL decline, pain, unsteady gait

Mood improvement^a

Clients with fewer depressive symptoms on the Depression Rating Scale at follow-up.

Stratification: IADL summary scale

Adjusted for: ADL decline, hospitalizations, depression rating scale score

Mood decline^a

Clients with more depressive symptoms on the Depression Rating Scale at follow-up. Includes clients with new depressive symptoms.

Stratification: ADL hierarchy scale

Adjusted for: clinical risk, difficulty bathing, institutional risk

Pain not controlled

Clients who have pain and are receiving inadequate pain control or no pain medication.

Adjusted for: clinical risk

Pain improvement^a

A reduction in pain since baseline.

Stratification: clinical risk

Adjusted for: unsteady gait, Cognitive Performance Scale score

Daily severe pain^a

Individuals with at least daily episodes of severe pain at follow-up.

Stratification: clinical risk

Adjusted for: dyspnea, unsteady gait, ADL long form score, ADL short form score, depression rating scale score

Continued caregiver distress

Clients with caregivers who express distress, anger and or depression at baseline and follow-up.

Stratification: Cognitive Performance Scale score

Adjusted for: not independent cognition, IADL difficulty, difficulty with locomotion, impaired decision making, difficulty with housework, clinical risk

Alone and distressed^a

Clients who are distressed by a decline in social activities and are alone for long periods or all the time at follow-up.

Stratification: clinical risk

Adjusted for: not independent cognition, pain, unsteady gait, Cognitive Performance Scale score, ADL hierarchy scale score, depression rating scale score

Used to go out^a

Clients who compared to the baseline assessment, go out less or not at all.

Adjusted for: IADL difficulty, Cognitive Performance Scale score

No flu vaccine

Clients who did not receive an influenza vaccination at either baseline or 6-month follow-up assessments

Stratification: clinical risk

Adjusted for: less than 2 h of daily activity, institutional risk, Cognitive Performance Scale score, depression rating scale score

Hospitalization and Emergency Department use^a

Clients who have been hospitalized or visited the emergency department in the 90 day period before the follow-up assessment.

Stratification: IADL capacity scale score

Adjusted for: physician visits, clinical risk, diabetes, depression rating scale score

Weight loss^a

Clients with any unintended weight loss at follow-up.

Adjusted for: clinical risk