Quality indicators for community care for older people: A systematic review.

Karlijn J Joling,Anja Declercq,Graziano Onder,Veerle R Smaardijk,Henriëtte G Van Der Roest,Hein P J Van Hout,Liza Van Eenoo,Davide L Vetrano,Lamberto Manzoli

doi:10.1371/journal.pone.0190298

Abstract

BackgroundHealth care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.MethodsRelevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.ResultsSearches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain ‘Additional evidence, formulation and usage’ (51%), followed by ‘Scientific evidence’ (39%) and ‘Stakeholder involvement’ (28%).ConclusionA substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.PROSPERO Registration: 2014:CRD42014007199

Highlights

In the world’s aging population, a growing number of older people will lead to a rapid increase in the demand for health care services
A substantial number of Quality Indicator (QI) is available to assess the quality of community care for older people
This is the first review that provides an overview of the QIs that are available to assess the quality of community care for older people and assessed their methodological quality

Summary

Introduction

In the world’s aging population, a growing number of older people will lead to a rapid increase in the demand for health care services. Current policies aim to follow up on this preference and strongly promote the use of community-based services, which is expected to help keeping health care sustainable. Almost 40% of public spending on health care concerns persons over 65 years of age, with long term care and hospital admissions being the most important cost drivers [5, 6]. Health care systems that succeed to provide effective community-based care and services are likely to optimise their public spending substantially [7]. Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. This systematic review identified existing QIs for community care for older people and assessed their methodological quality

Methods

Results

Discussion

Conclusion