Healthcare Areas

Information in this chart comes from the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS) and shows the proportion of residents at risk of decline in health across the population of long term care residents in Alberta.

This scale measures frailty, health instability, and decline in health status among long term care residents, some of whom have end-stage disease diagnoses. This assessment considers the resident’s status over the last 90 days and evaluates common signs of poor health, including decreased appetite, dehydration, vomiting, weight loss, shortness of breath, as well as, worsened decision making, decline in activities of daily living, and end-stage disease.

The range of values for this assessment is 0 (no health instability) to 5 (very high health instability). A higher score on the scale indicates the presence of more medical complexity and a higher risk of serious decline in health status. Higher scores on this scale have also been found to predict adverse outcomes such as hospitalization and mortality (Hirdes, Frijters & Teare, 2003; Mor et al., 2011).

This chart shows the percentage of long term care residents who are stable or who have a low risk of decline (score of 0), intermediate risk of decline or moderately stable (score of 1), and a high risk of decline or unstable (score of 2 or more) over time.

The information in this chart can best inform system-level planning for quality improvement, program development, and resource allocation. This is because this data, when reported at an aggregate level, provides a description of the population that requires services in relation to frailty and risk of health decline. It does not describe the quality of care or services provided at a site.

When thinking about this information, providers and leaders can consider a number of things to better understand these results. Some questions they should consider before taking action include:

• How would you describe the frailty and risk of health decline of the long term care resident population across Alberta? What might the proportion of long term care residents with a high risk of decline mean for program planning? Quality Improvement? Resource allocation?
• Given that the population of long term care residents in Alberta has varying levels of frailty and risk of health decline, what types of care, supports, and services are required to ensure safety and quality? Consider the different needs of residents and their families, sites, and zones.
• What are some leading care practices and interventions that can reduce the risk of adverse outcomes (e.g., dehydration, weight loss) for long term care residents with a higher risk of health decline? Are there additional opportunities to leverage these practices in Alberta?

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality: Acceptability, Accessibility, Appropriateness, Effectiveness, Efficiency, and Safety.

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