Table 1

ROSA home care outcome monitoring system quality and safety indicators

	Indicator	Main data source	Numerator	Denominator	Exclusions/stratification*	Covariates*
Medication-related indicators
1	High sedative load	Medications (PBS)	Number of HCP episodes where recipients experienced a high sedative load	Number of HCP episodes	Stratified by dementia status. Exclude history of cancer, schizophrenia and Huntington’s disease.	Age, sex and number health conditions.
2	Antipsychotic use	Medications (PBS)	Number of HCP episodes where recipients had been dispensed an antipsychotic medication.	Number of HCP episodes	Stratified by dementia status. Exclude history of schizophrenia or Huntington’s disease.	Age, sex, number health conditions† and prior antipsychotic use.
3	Chronic opioid use	Medications (PBS)	Number of HCP episodes where recipients are chronic opioid users, defined as continuous opioid use for at least 90 days, or for 120 non-consecutive days.	Number of HCP episodes	Exclude history of cancer.	Age, sex and number health conditions.
4	Antibiotic use	Medications (PBS)	Number of HCP episodes where recipients were dispensed an antibiotic	Number of HCP episodes		Age, sex and number health conditions.
Hospitalisation/mortality-related indicators
5	Premature mortality	Mortality records (NDI)	Number of HCP episodes where recipients died from premature causes, that is, main cause of death is ‘external’ and considered potentially avoidable.	Number of HCP episodes		Age, sex and number health conditions.
6	Falls	Hospital and mortality (NDI) records	Number of HCP episodes where recipients had a fall that resulted in hospitalisation/ED presentation	Number of HCP episodes		Age, sex and number health conditions‡ and dementia.
7	Fractures	Hospital, mortality (NDI) subsidised health service records (MBS)	Number HCP episodes where recipients had a fracture requiring hospitalisation/ED presentation.	Number of HCP episodes		Age, sex, number health conditions‡, dementia and osteoporosis.
8	Medication-related adverse events	Hospital records	Number of HCP episodes where recipients had a medication-related hospitalisation/ED presentation	Number of HCP episodes		Age, sex and number health conditions.
9	Weight loss and malnutrition	Hospital records	Number of HCP episodes where recipients had a hospitalisation/ED presentation for malnutrition or weight loss	Number of HCP episodes	Exclude history of cancer.	Age, sex and number health conditions.
10	Delirium and/or dementia hospitalisations	Hospital records	Number of HCP episodes where recipients had dementia and a hospitalisation/ED presentation for dementia and/or delirium	Number of HCP episodes with dementia recipient		Age, sex and number health conditions.
11	ED Presentation	Hospital records	Number of HCP episodes ED presentation within 30 days of discharge from hospital	Number of HCP episodes with hospitalisation		Age, sex, number health conditions and history of prior hospitalisations.
12	Pressure injury	Hospital records	Number of HCP episodes where recipients had a hospitalisation/ED presentation for pressure injury	Number of HCP episodes		Age, sex and number health conditions.
Process-related indicators
13	Chronic disease management plan	Subsidised health service records (MBS)	Number of HCP episodes where eligible recipients§ had a chronic disease management plan	Number of HCP episodes	Exclude DVA card holders¶	Age, sex and number health conditions.
14	Home medicines review	Subsidised health service records (MBS)	Number of HCP episodes where eligible recipients§ had a home medicines review	Number of HCP episodes	Exclude DVA card holders¶	Age, sex and number health conditions
15	Wait-time	ACAP records	Wait time from ACAP assessment approval to commencement of first HCP, median days (IQR)	N/A

*All health conditions determined using Rx-Risk-V comorbidity index in 6 months prior to HCP episode, apart from dementia and cancer, which included Rx-Risk-V and ACAP; schizophrenia and Huntington’s disease from ACAP. History of prior hospitalisations (unplanned admissions) 12 months prior.
†Psychotic illness removed from the count of health conditions as included as covariate in model.
‡Dementia and osteoporosis removed from count of health conditions, where appropriate, as included as covariates in model.
§Chronic disease management plans and home medication reviews can be claimed once in a 12-month period, and only eligible HCP recipients were included in the denominator.
¶DVA card holders were excluded as these items are reimbursed through DVA and may not be fully captured in the dataset.
ACAP, Aged Care Assessment Program; DVA, Department of Veterans’ Affairs; ED, emergency department; MBS, Medicare Benefits Schedule; NDI, National Death Index; PBS, Pharmaceutical Benefits Scheme; ROSA, Registry of Senior Australians.