Table 1 Selected dimensions when assessing facilities for high use of acute hospitalisations

Research question: to …

• Find the fewest facilities to accumulate numbers of hospital events?

• Identify resident- or facility-level characteristics associated with higher (or lower) event rates so as to inform intervention design?

• Find facilities that have high hospital presentation rates even if explained by resident characteristics?

• Find facilities that, independently of their facility or resident characteristics, have high event rates?

• Find facilities that after adjusting for non-modifiable characteristics, have unexplained high rates of presentations?

Hospital event type as endpoint of interest

• All hospital visits, or acute/ED presentations, or acute admissions?

• All or selected diagnoses only, e.g. those classified as potentially avoidable (PAH)?

• If only selected diagnoses, e.g. PAH, were codes predefined or selected/amended after data was gathered?

LTC facility type

• Limit to particular facility types – e.g. lower-level care?

• Use only facilities with complete or near-complete data?

• Is distance or time to hospital likely to impact referral decisions?

• Use only facilities of a certain size (for power & cost considerations)

• Need to stratify by e.g. geography, or match in pairs for randomisation?

Resident care type

• Use only long-stay residents, or include short-stayers?

• Limit to those in certain levels of care, e.g. low-level care, or dementia care, or in one age group, or those with public funding, or those with a particular clinical history?

Cohort assembly

• Include all residents at any one time, i.e. cross-sectional?

Or all entering (or leaving) the facility during a pre-defined period?

Or all using the facility at any time during a period?

Time period of events

• Hospital events over what time period?

• Data collected retrospectively or prospectively?

• In a special study, or with routine data collection?

Adjustments during analysis

• Can results consider person-time, e.g. on death or moving away?

• Can results consider facility-level characteristics? If so, how?

• Can results consider resident-level characteristics? If so, how?

Measure for reporting and ranking

• Report a count, a proportion, a rate over time, a facility-related effect size from model, a residual from a fitted statistical model, or a change in rank between two methods?

• Express as rate per bed, per resident, per resident year, or relative to other facilities, to an earlier report or to a “best practice” target?

Data quality, completeness & recency

• What is the extent of missingness in data – facilities, outcomes or data items?

• Is missing data correlated with particular variables so as to lead to bias?

• Are data current, or could changes have occurred since collection?

• How reliable are measures, ratings, and coding?