Eshetie Tesfahun C, Caughey Gillian E, Lang Catherine, Ryan Olivia, Visvanathan Renuka, Whitehead Craig, Evans Keith, Sluggett Janet K, Khadka Jyoti, Dawkins Carolyn, Williams Helena, Starke Miranda, Blunt Sara, Liddell Anne, Corlis Megan, Sheppeard Anna, Lello Penelope, von Thien Marilyn, Wesselingh Steven L, Inacio Maria C
Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA.
Caring Futures Institute, Flinders University, Adelaide, SA.
Med J Aust. 2025 Aug 18;223(4):189-196. doi: 10.5694/mja2.52709. Epub 2025 Jun 24.
To examine the prevalence of and variation in indicators of the quality and safety of care provided to older Australians who received subsidised long term care during 2019, by type of care (residential aged care or home care packages).
Cross-sectional population-based study; analysis of linked data from the Registry of Senior Australians (ROSA) National Historical Cohort (National Aged Care Data Clearinghouse, National Death Index, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme databases; South Australian, New South Wales, Victorian, and Queensland hospital admissions and emergency department [ED] presentations databases).
SETTING, PARTICIPANTS: All people in the ROSA National Historical Cohort who received residential or home-based aged care during the 2019 calendar year.
Risk-adjusted prevalence estimates (with 95% confidence intervals, CIs) for quality and safety indicators of care (twelve for residential care, fifteen for home care packages); proportions by indicator of outlier residential facilities and home care services (outside 95% CI for mean value) as a measure of variation in quality of care.
In 2019, 244 754 people received residential aged care in 2746 facilities; 149 104 people received home care packages through 2407 home care services. For residential aged care, indicator prevalence and variation were highest for antibiotic use (prevalence: 64.5% [95% CI, 64.3-64.7%]; 13.9% of facilities beyond upper 95% CI bound), high sedative load (prevalence: 45.2%, [95% CI, 45.0-45.4%]; 12.4% beyond upper 95% CI bound), and ED presentations (prevalence: 37.8% [95% CI, 37.6-38.0%]; 19.3% beyond upper 95% CI bound). For home care services, indicator prevalence and variation were highest for waiting time longer than six months (prevalence: 81.8% [95% CI, 81.4-82.1%]; 17.5% of services beyond upper 95% CI bound), ED presentations (prevalence: 43.2% [95% CI, 43.0-43.5%]; 14.7% beyond upper 95% CI bound), chronic disease management plans (prevalence: 43.2% [95% CI, 42.9-43.5%]; 12.9% below lower 95% CI bound), and home medicines reviews (prevalence: 3.2% [95% CI, 3.1-3.3%]; 28.9% below lower 95% CI bound). The proportions of home care recipients were larger than for facility residents for hospitalisations with delirium/dementia (home care, 10.5% [95% CI, 10.1-10.9%]; residents, 4.3% [95% CI, 4.2-4.4%]), weight loss/malnutrition (home care, 5.5% [95% CI, 5.3-5.6%]; residents, 2.5% [95% CI, 2.4-2.6%]), or medication-related events (home care, 4.6% [95% CI, 4.5-4.7%]; residents, 2.4% [95% CI, 2.3-2.5%]).
The marked national variations by residential or home aged care provider in antibiotic use, ED presentations, high sedative load, longer waiting times for home care services, home medicines reviews, and chronic disease management plans suggest these areas could benefit from targeted quality improvement strategies.
按护理类型（老年护理院或居家护理包），调查2019年接受补贴长期护理的澳大利亚老年人所获护理质量与安全指标的患病率及差异。
基于人群的横断面研究；对来自澳大利亚老年人登记册（ROSA）国家历史队列（国家老年护理数据中心、国家死亡索引、医疗保险福利计划、药品福利计划数据库；南澳大利亚州、新南威尔士州、维多利亚州和昆士兰州医院入院和急诊科就诊数据库）的关联数据进行分析。
背景、参与者：ROSA国家历史队列中在2019日历年接受过老年护理院或居家老年护理的所有人。
护理质量与安全指标的风险调整患病率估计值（95%置信区间，CI）（老年护理院为12项，居家护理包为15项）；按指标划分的异常老年护理院设施和居家护理服务比例（超出均值95%CI范围），作为护理质量差异的衡量指标。
2019年，2746家机构中有244754人接受老年护理院护理；2407项居家护理服务中有149104人接受居家护理包服务。对于老年护理院护理，抗生素使用的指标患病率和差异最高（患病率：64.5%[95%CI，64.3 - 64.7%]；13.9%的机构超出95%CI上限）、高镇静剂负荷（患病率：45.2%，[95%CI，45.0 - 45.4%]；12.4%超出95%CI上限）以及急诊科就诊（患病率：37.8%[9_5%CI，37.6 - 38.0%]；19.3%超出95%CI上限）。对于居家护理服务，等待时间超过6个月的指标患病率和差异最高（患病率：81.8%[95%CI，81.4 - 82.1%]；17.5%的服务超出95%CI上限）、急诊科就诊（患病率：43.2%[95%CI，43.0 - 43.5%]；14.7%超出95%CI上限）、慢性病管理计划（患病率：43.2%[95%CI，42.9 - 43.5%]；12.9%低于95%CI下限）以及居家药物审查（患病率：3.2%[95%CI，3.1 - 3.3%]；28.9%低于95%CI下限）。居家护理接受者因谵妄/痴呆住院（居家护理，10.5%[95%CI，10.1 - 10.9%]；机构居民，4.3%[95%CI，4.2 - 4.4%]）、体重减轻/营养不良（居家护理，5.5%[95%CI，5.3 - 5.6%]；机构居民，2.5%[95%CI，2.4 - 2.6%]）或药物相关事件（居家护理，4.6%[95%CI，4.5 - 4.7%]；机构居民，2.4%[95%CI，2.3 - 2.5%]）的比例高于机构居民。
老年护理院或居家老年护理提供者在抗生素使用、急诊科就诊、高镇静剂负荷、居家护理服务等待时间延长、居家药物审查和慢性病管理计划方面存在明显的全国性差异，表明这些领域可能受益于有针对性的质量改进策略。
