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ITAC 2024: Digital maturity, star ratings and their effects on the quality of care

25 March 2024
By Kate McDonald
Columbia University professor Greg Alexander. Photo courtesy Event Photography

Mounting evidence is showing that increases in the digital maturity of aged care organisations has a measurable effect on the quality of care they provide, including reductions in UTIs and antibiotic use and a reduction in the severity of poorer quality care.

Evidence also shows that star ratings do work in improving understanding of whether a facility is operating safely or not.

Nursing informaticist Greg Alexander, a professor of nursing at the Columbia School of Nursing in the US, has led a number of studies that benchmark national trends in IT adoption and the impact on quality measures in nursing homes.

Professor Alexander has conducted an annual survey for over a decade, collecting eight years of data on digital maturity and informing the development of a seven-stage model that is used to benchmark long-term care.

The model starts at stage zero, where there is no technology to speak of, and goes up to stage six, where residents can access data and have some input into it, and where there is a high degree of clinical and predictive analytics.

The research has also been informing the Australian aged care sector and guided the Aged Care Industry IT Council’s recent Digital Maturity in Aged and Community Care report. Professor Alexander will be discussing it at the ITAC conference on the Gold Coast this week.

The survey used in the research was based on Professor Alexander’s staged model, and covered three domains – residential care, clinical support, and administrative activities – scoring their maturity in terms of IT capabilities, IT extent of use, and IT degree of integration.

In the US, Professor Alexander’s research shows that measuring digital maturity and using digital tools actually does affect the quality of care.

“We have one study that we’ve published that shows that for each increment of stage improvement, so in each increment of IT maturity, there is about a 10 per cent decrease in the number of urinary tract infections that occur,” Prof Alexander said.

“We also find in these settings, where digital maturity is improving, that there’s a reduction in the use of antibiotic medications. We also looked at safety of care delivery and found that as IT maturity improves, the scope and deficiency of care – in other words the severity of deficiency – is lower and patients aren’t exposed to as risky types of care delivery.

“It’s associated with documentation and with passing on information and having complete and timely information.”

This research is being used in the US for benchmarking, but it can also be used to provide guidance on how to uplift digital maturity. Prof Alexander said most aged care facilities that he has seen in Australia don’t have internal IT departments. While they have corporate IT, there is little specialism in clinical IT, and that enables gaps in care delivery.

Professor Alexander has also done quite a lot of work on star ratings, which has informed the development of Australia’s system. While the implementation of the Australian Department of Health and Aged Care has been somewhat controversial, Prof Alexander says they actually do work.

“We’ve had them for many, many years in the US, and they are intended to provide a level of understanding at a glance about how a facility is operating, whether it’s operating safely or whether it’s not.

“I think they’re an important thing but the general public public probably doesn’t understand how the quality rating systems are configured, and what a four star means versus a one star. In the US, they’re based on staffing hours, and they’re based on safety deficiencies. And there are a lot of different quality metrics that go into the star rating.

“But star ratings and the metrics around those aren’t really used like they’re intended. People are going to be put in to a home that has space and that’s willing to take them according to their needs, and not necessarily based on who provides the best quality placement decisions.

“I think it’s getting better and there are nursing homes that have the ability to have better digital maturity and are being recognised as being able to share data more. Hospitals are being held accountable for exchanging data and information as well.”

Professor Alexander will be speaking at the ITAC conference on Tuesday, March 26, and taking part in a panel session discussing the Digital Maturity in Aged and Community Care report.

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