Topic: ROSA Outcome Monitoring System – Quality and Safety Indicators for Aged Care in Australia

Day: Thursday 22 October 2020

Time:  1:30pm-1:50pm AEDT


Background: The Registry of Senior Australians (ROSA) has developed an Outcome Monitoring System (OMS) to allow effective evaluation of the quality and safety of care provided to older individuals accessing aged care services. The ROSA OMS was designed to be a pragmatic and low burden tool to support evidence-based quality and safety improvement, encouraging transparency and best practices within the sector. By using routinely collected data available from the State and Commonwealth governments, the ROSA OMS eliminates the burden of collecting new information from aged care residents or providers. Importantly, each indicator is risk-adjusted to account for the varying profile of individuals living in each facility. Here we describe the ROSA OMS and present the variation in care as measured by these indicators in Australian residential aged care (RAC) in 2016.

Methods: The ROSA OMS indicators were developed using literature review and expert engagement, including with geriatricians, general practitioners, and representatives from aged care providers, peak bodies and consumers. The 12 quality and safety indicators developed include: falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department encounters, pressure injuries, sedative load, antipsychotic use, chronic opioid use, antimicrobial use, and premature mortality. They were selected as they have been implemented or recommended in other countries, or have been associated with poor outcomes, and can be measured using the routinely collected data accessible in ROSA. Prevalence of indicators and variation by facilities during 2016 were examined using national data sources (5 indicators) and South Australian (SA) state health records (7 indicators).

Results: In 2016, 208,355 older people lived in 2,690 RAC facilities nationally with 18,956 in 254 RAC facilities in SA. Using national data, we found two thirds (67.5%) of residents used antibiotics, 48.1% experienced a high sedative load, 26.8% were exposed to chronic opioid use and 23.5% were using antipsychotic medication. Using SA state-based data, 19.1% returned to the emergency department within 30 days of being discharged from hospital, 10.1% had at least one fall requiring medical attention, and 2.3% of residents living with dementia were hospitalised for dementia/delirium-related episodes.

Conclusions: The ROSA OMS is a pragmatic, efficient, and low burden tool to support evidence-based quality and safety improvement initiatives urgently needed for the aged care sector. It can be used to address the Royal Commission into Aged Care Quality and Safety’s concerns regarding the need for “Unbiased measurement and reporting of performance … in the aged care sector”.


Dr Sarah Bray is an experienced postdoctoral researcher and project manager, passionate about science engagement with the wider community. Sarah has worked on a diverse range of projects over her career, from medical research in cancer biology (leukaemia and rare blood disorders) to her PhD project wrangling ancient DNA from extinct bears.

Over the last decade, her roles have shifted from laboratory-based positions to project management and high-level research support. In her current role at SAHMRI, Sarah helped to establish and develop the Registry of Senior Australians (ROSA), including coordinating the complex ethics and governance requirements for this ambitious national ‘Big Data’ resource that linked the health and aged care sectors with the aim of improving the lives of all Australians using aged care. She also leads the consumer and community engagement activities for ROSA.