Skip to main content Accessibility help

Assessing the Quality of Care Provided to Older Persons with Frailty in Five Canadian Provinces, Using Administrative Data

  • Cynthia Kendell (a1), Beverley Lawson (a2), Joseph H. Puyat (a3), Robin Urquhart (a1) (a4), Arminée Kazanjian (a3), Grace Johnston (a5), Sharon E. Straus (a6) (a7), Pierre Durand (a8) (a9) (a10), Lucille Juneau (a8) (a9), Alexis F. Turgeon (a10) (a11), France Légaré (a9) (a10) (a12), Michèle Aubin (a8) (a9) (a10) (a12), Louis Rochette (a13) and Anik M.C. Giguere (a8) (a9) (a10) (a12)...


We examined the quality of care provided to older persons with frailty in five Canadian provinces, using administrative health data. In each province, we identified two cohorts of older persons with frailty: decedents and living persons. Using decision rules, we considered individuals to be frail if they were long-term care residents, terminally ill, or met at least two of seven domains, which were based on frailty scales, geriatrician discussions, and health service utilization indicators. We assessed quality of care using selected quality indicators: decrease in length of hospital stay, decrease in the number of in-patient readmissions, decrease in the number of emergency department visits, increase in the level of family physician continuity of care, decrease in the use of mechanical ventilation, and decrease in the number of admissions to intensive care. Using regression analyses, we also found male sex and older age were associated with poorer quality of care in both cohorts. This study provides baseline data for evaluating future efforts to improve the quality of care provided to older persons with frailty.

Nous avons examiné la qualité des soins fournis aux personnes âgées fragiles dans cinq provinces canadiennes à partir de données administratives sur la santé. Dans chaque province, nous avons considéré les personnes âgées fragiles en fonction de deux cohortes : les personnes décédées et les personnes vivantes. Des règles de décision ont été utilisées pour déterminer quelles personnes étaient frêles, soit celles résidant en établissement de soins de longue durée, qui étaient en phase terminale ou dont le profil correspondait à deux des sept domaines identifiés. Ces domaines étaient fondés sur des échelles de fragilité, des discussions avec des gériatres et des indicateurs d’utilisation des services de santé. Nous avons évalué la qualité des soins à l’aide des indicateurs de qualité suivants : diminution de la durée de l’hospitalisation, diminution du nombre de réadmissions à l’hôpital, diminution du nombre de visites à l’urgence, augmentation de la continuité des soins fournis par un médecin de famille, diminution de l’utilisation de la ventilation mécanique et diminution du nombre d’admissions aux soins intensifs. À l’aide d’analyses de régression, nous avons également constaté que le sexe masculin et l’âge avancé étaient associés à une moins bonne qualité de soins dans les deux cohortes. Cette étude fournit des données de base qui permettront d’évaluer les futurs efforts visant à améliorer la qualité des soins offerts aux personnes âgées fragiles.


Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Anik M.C. Giguere, Ph.D. Laval University Pavillon Ferdinand-Vandry, Office 2881-C 1050 Avenue de la Médecine Québec (QC) Canada, G1V 0A6 (


Hide All

A.M.C.G., C.K., B.L., and R.U. conceived and designed this study. All authors contributed to the interpretation of findings. A.M.C.G. and C.K. wrote the first draft of this manuscript. All authors revised and approved the final manuscript. We gratefully acknowledge Sharon Jhang, Jim Si, Refik Saskin, and Alejandro Gonzalez for conducting the analyses in Alberta, Ontario, and Quebec. We also acknowledge the help of Jayna Holroy-Leduc in accessing data in Alberta, and the help of Serge Dumont and Helena Daudt in selecting the quality indicators. This research was funded by the Canadian Frailty Network, which is supported by the Government of Canada through the Networks of Centres of Excellence (NCD) program. We also received funding from University Laval Research Chair on Aging (Quebec City), and in-kind contributions from the Quebec Excellence Centre on Aging (Quebec City). A.F.T. is the Canada Research Chair in Critical Care Neurology and Trauma. A.M.C.G. is funded by a Research Scholar Junior 2 Career Development Award by the Fonds de Recherche du Québec—Santé.



Hide All
Allin, S. (2008). Does equity in healthcare use vary across Canadian provinces? Healthcare Policy, 3(4), 8399.
Bagshaw, S., Stelfox, H., McDermid, R., Rolfson, D., Tsuyuki, R., Baig, N., et al. (2014). Association between frailty and short- and long-term outcomes among critically ill patients: A multicentre prospective cohort study. Canadian Medical Association Journal, 186(2), E95102. doi: 10.1503/cmaj.130639
Bellows, J., Young, S., & Chase, A. (2014). Person-focused care at Kaiser Permanente. The Permanente Journal, 18(1), 9091. doi:10.7812/TPP/13-165
Bertakis, K., Azari, R., Helms, L., Callahan, E., & Robbins, J. (2000). Gender differences in the utilization of health care services. Journal of Family Practice, 49(2), 147152.
Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ, 346, f167. doi:10.1136/bmj.f167
Buckinx, F., Rolland, Y., Reginster, J.-Y., Ricour, C., Petermans, J., & Bruyère, O. (2015). Burden of frailty in the elderly population: Perspectives for a public health challenge. Archives of Public Health, 73(1), 19. doi: 10.1186/s13690-015-0068-x
Canadian Frailty Network. (2016). Frailty in Canada. Retrieved 31 July 2018 from
Courtenay, W. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science and Medicine, 50, 13851401.
Dartmouth Institute for Health Policy and Clinical Practice (2017). The Dartmouth atlas of health care. Retrieved 31 July 2018 from
Earle, C., Park, E., Lai, B., Weeks, J., Ayanian, J. Z., & Block, S. (2003). Identifying potential indicators of the quality of end-of-life cancer care from administrative data. Journal of Clinical Oncology, 21(6), 11331138. doi: 10.1200/JCO. 2003.03.059
Fast, J. (2015). Caregiving for older adults with disabilities present costs, future challenges. Retrieved 31 July 2018 from Montreal:
Forbes, D., Jansen, S. L., Markle-Reid, M., Hawranik, P., Morgan, D., Henderson, S., et al. (2008). Gender differences in use and availability of home and community-based services for people with dementia. Canadian Journal of Nursing Research, 40(1), 3959.
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146M156.
Garre-Olmo, J., Calvó-Perxas, L., López-Pousa, S., de Gracia Blanco, M., & Vilalta-Franch, J. (2013). Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age and Ageing, 42(1), 4651. doi: 10.1093/ageing/afs047
Giguere, A. M. C., Holroyd-Leduc, J. M., Straus, S. E., Urquhart, R., Dumont, S., Durand, P. J., et al. Prioritization of indicators of the quality of care provided to frail seniors by key stakeholders from five Canadian provinces. In prepapration.
Glazier, R., Tepper, J., Agha, M. M., & Moineddin, R. (2006). Primary care in disadvantaged populations. In Upshur, R., Klein-Geltink, J. (Ed.), Primary care in Ontario: ICES atlas (pp. 121140). Toronto: Institute for Clinical Evaluative Sciences.
Grunfeld, E., Johnston, G., Mykhalovskiy, E., Cicchelli, L., McIntyre, P., Burge, F., et al. (2006). Quality indicators for end-of-life breast cancer care: Is their agreement between stakeholder groups? Journal of Palliative Care, 22(3), 200.
Heyland, D., Dodek, P., Rocker, G., Groll, D., Gafni, A., Pichora, D., et al. (2006). What matters most in end-of-life care: Perceptions of seriously ill patients and their family members. Canadian Medical Association Journal, 174(5), 627633.
Heyland, D., Lavery, J., Tranmer, J., Shortt, S., & Taylor, S. (2000). Dying in Canada: Is it an institutionalized, technologically supported experience? Journal of Palliative Care, 2000(Suppl. 16), S1016.
Higashi, R. T., Tillack, A. A., Steinman, M., Harper, M., & Johnston, C. B. (2012). Elder care as “frustrating” and "boring": Understanding the persistence of negative attitudes toward older patients among physicians-in-training. Journal of Aging Studies, 26(4), 476483. doi: 10.1016/j.jaging.2012.06.007
Hoover, M., Roterman, M., Sanmartin, C., & Bernier, J. (2013). Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Reports, 24(9), 1017.
Jones, J., & Hunter, D. (1995). Consensus methods for medical and health services research. BMJ, 311(7001), 376380.
Kazanjian, A., Morettin, D., & Cho, R. (2004). Health care utilization by Canadian women. BMC Women’s Health, 4(Suppl. 1), S33.
Kent, J. A., Patel, V., & Varela, N. A. (2012). Gender disparities in health care. Mount Sinai Journal of Medicince, 79(5), 555559.
Lemstra, M., Mackenbach, J., Neudorf, C., & Nannapaneni, U. (2009). High health care utilization and costs associated with lower socio-economic status: Results from a linked dataset. Canadian Journal of Public Health, 100(3), 180183.
Magill, M., & Senf, J. (1987). A new method for measuring continuity of care in family practice residencies. Journal of Family Practice, 24(2), 165168.
Mainz, J. (2003). Defining and classifying clinical indicators for quality improvement. International Journal for Quality in Health Care, 15(6), 523530.
Makizako, H., Shimada, H., Tsutsumimoto, K., Lee, S., Doi, T., Nakakubo, S., et al. (2015). Social frailty in community-dwelling older adults as a risk factor for disability. Journal of the American Medical Directors Association, 16(11), 1003.e1007-1003.e1011.
Organisation for Economic Co-operation and Development. (2017). Recommendations to OECD ministers of health from the high level reflection group on the future of health statistics: Strengthening the international comparison of health system performance through patient-reported indicators. Paris, France: Organization for Ecomonic Co-Operation and Development (OECD). (2017). Ministerial Statement. The Next Generation of Health Reforms: OECD Health Ministerial Meeting. Retrieved 31 July 31 2018 from
Owens, G. M. (2008). Gender differences in health care expenditures, resource utilization, and quality of care. Journal of Managed Care Pharmacy, 14(Suppl. 3), S2S6.
Pampalon, R., Hamel, D., Gamache, P., & Raymond, G. (2009). A deprivation index for health planning in Canada. Chronic Diseases in Canada, 29(4), 178191.
Patel, K., Brennan, K., Brennan, M., Jupiter, D., Shar, A., & Davis, M. (2014). Association of a modified frailty index with mortality after femoral neck fracture in patients aged 60 years and older. Clinical Orthopaedics and Related Research, 472(3), 10101017. doi: 10.1007/s11999-013-3334-7
Protière, C., Viens, P., Rousseau, F., & Moatti, J. P. (2010). Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy? Critical Reviews in Oncology/Hematology, 75(2), 138150. doi: 10.1016/j.critrevonc.2009.09.007
Redondo-Sendino, Á., Guallar-Castillón, P., Banegas, J. R., & Rodríguez-Artalejo, F. (2006). Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health, 6, 155.
Rockwood, K., Howlett, S. E., MacKnight, C., Beattie, B. L., Bergman, H., Hébert, R., et al. (2004). Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: Report from the Canadian study of health and aging. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(12), 13101317.
Somogyi-Zalud, E., Zhong, Z., Hamel, M. B., & Lynn, J. (2002). The use of life-sustaining treatments in hospitalized persons aged 80 and older. Journal of the American Geriatrics Society, 50(5), 930934.
Statistics Canada. (2010). Population Projections for Canada, Provinces and Territories—2009–2036. Retrieved 31 July 2018 from
Tiagi, R. (2016). How equitable is health care utilization among older adults in Canada? Journal of Population Ageing, 9(3), 191205. doi: 10.1007/s12062-015-9133-z
Urquhart, R., Giguere, A. M. C., Lawson, B., Kendell, C., Holroyd-Leduc, J. M., & Johnston, G. M. (2017). Rules to identify persons with frailty in administrative health databases. Canadian Journal on Aging / La Revue Canadienne du Vieillissement, 36(4), 514–21.
Williams, A., Lum, J., Morton-Chang, F., Kuluski, K., Peckman, A., Warrick, N., et al. (2016). Integrating long-term care into a community-based continuum: Shifting from “beds” to “places”. Retrieved 31 July 31 2018 from:
Woz, S., Mitchell, S., Hesko, C., Paasche-Orlow, M., Greenwald, J., Chetty, V. K., et al. (2012). Gender as risk factor for 30 days post-discharge hospital utilisation: a secondary data analysis. BMJ Open, 2(2), e000428. doi: 10.1136/bmjopen-2011-000428


Assessing the Quality of Care Provided to Older Persons with Frailty in Five Canadian Provinces, Using Administrative Data

  • Cynthia Kendell (a1), Beverley Lawson (a2), Joseph H. Puyat (a3), Robin Urquhart (a1) (a4), Arminée Kazanjian (a3), Grace Johnston (a5), Sharon E. Straus (a6) (a7), Pierre Durand (a8) (a9) (a10), Lucille Juneau (a8) (a9), Alexis F. Turgeon (a10) (a11), France Légaré (a9) (a10) (a12), Michèle Aubin (a8) (a9) (a10) (a12), Louis Rochette (a13) and Anik M.C. Giguere (a8) (a9) (a10) (a12)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed