The Trajectories Project
The Trajectories project studied modifiable symptoms and potentially inappropriate care practices experienced by residents in Canadian nursing homes near the end of life. The project was conceived after conversations with people working in the nursing home system, partnering TREC researchers with care providers and decision makers. It used TMS data to determine which symptoms and practices place the most burden on residents, and to develop and evaluate ways to measure and monitor burden. In all sites, the burden of modifiable symptoms worsens as the end of life approaches. However, nursing homes with better work environments have lower rates of burdensome resident symptoms. This is significant because work environment is modifiable.
When a provincial health minister asked if TREC could use TMS data to detect shifts in nursing home quality at the system level, the Canary project was born (named for the birds that miners carried into tunnels to warn of dangerous gases—an early detection system).
The Canary Project
Canary is a “proof of concept” project, using TREC data to build an indicator that measures the overall health of the system. The goal was a single composite indicator that could be monitored every three months to signal quality at the system level. It is based on 12 carefully chosen quality indicators from standardized resident assessment data that is collected by all Canadian nursing homes.
The Canary team has completed stage 1 of this work, showing that watching this score over time can show how changes affect the system. For instance, in 2010 Alberta began using funding for long-term care that is based on patient and health needs. The Canary score changed, with some indicators getting better and some worsening. One key take-home message is that quality indicators need to be monitored when changes are implemented as often when one improves in response to a change, another will worsen (because there are finite resources in the system).
Early application of the Canary score to seasonal flu data has been promising, showing a predictable pattern of lagged quality worsening after each flu outbreak.The Canary team will assess the score’s validity with data from the Canadian Institute for Health Information. TREC’s goal is to hand the scoring technique over to decision makers in health ministries and regions, allowing them to generate their own reports and readily monitor quality of care at a system level.