Abstract
BackgroundPerformance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. We are, however, still far from being able to refer to a common set of indicators at the European level.We therefore demonstrate the calculation of Long Term Care Facility Quality Indicators (LTCFQIs) from data of the European Services and Health for Elderly in Long TERm Care (SHELTER) project. We explain how risk factors are taken into account and show how LTC facilities at facility and country level can be compared on quality of care using thresholds and a Quality Indicator sum measure.MethodsThe indicators of Long Term Care Facility quality of care are calculated based on methods that have been developed in the US. The values of these Quality Indicators (QIs) are risk adjusted on the basis of covariates resulting from logistic regression analysis on each of the QIs. To enhance the comparison of QIs between facilities and countries we have used the method of percentile thresholds and developed a QI sum measure based on percentile outcomes.ResultsIn SHELTER data have been collected with the interRAI Long Term Care Facility instrument (interRAI-LTCF). The data came from LTC facilities in 7 European countries and Israel. The unadjusted values of the LTCF Quality Indicators differ considerably between facilities in the 8 countries. After risk adjustment the differences are less, but still considerable. Our QI sum measure facilitates the overall comparison of quality of care between facilities and countries.ConclusionsWith quality indicators based on assessments with the interRAI LTCF instrument quality of care between LTC facilities in and across nations can be adequately compared.
Highlights
Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery
Quality Indicators (QIs) for monitoring quality of care in nursing homes have been developed using assessment data from the widely implemented Resident Assessment Instrument (RAI) for Long Term Care [2,3,4]. Routine monitoring of these QIs led to QI reports being used for best practice comparison between nursing homes
A study commissioned by the US Centers for Medicare and Medicaid Services (CMS) demonstrated that the items from routine use of the RAI for Long Term Care in US Nursing Homes are reliable and that they can be used for the stimulation of improvement of care and reporting to the general public [5,6]
Summary
Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. Quality Indicators (QIs) for monitoring quality of care in nursing homes have been developed using assessment data from the widely implemented Resident Assessment Instrument (RAI) for Long Term Care [2,3,4]. Routine monitoring of these QIs led to QI reports being used for best practice comparison between nursing homes. The relationship between outcomes and good and bad care practices were not strong for all available QIs, 10 QIs had a good enough relationship between identifiable pro-active and responsive care practices These QIs have been selected by CMS for periodically public reporting at facility level
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