Measuring quality and standards of long-term care for older people

Abstract

Measuring the quality of long-term care is important for establishing standards of care and monitoring the performance of service providers, in addition to enhancing consumer choice and competition. Information on quality allows both purchasers and consumers to make informed decisions on providers based on performance, and to ascertain whether standards are achieved. Further, public reporting of provider performance across quality indicators spurs greater participation of providers in national and regional quality improvement initiatives. Quality measurement involves collecting information on a variety of accepted quality indicators to assess the care given to older people across a variety of care settings, but most commonly in nursing homes and home health services. Quality of care is measured by using structure, process, or outcome indicators at both patient and provider-levels. Several countries, most notably the U.S., collect these measures using standardised and mandatory patient assessment systems. While existing evidence suggests that the adoption of such systems has lead to quality improvement, there are a number of important methodological challenges that limit the effectiveness and benefits of quality measurement. To advance toward better quality assurance, various initiatives and reforms have been developed. The majority of improvements in this area have occurred in the U.S., with the European experience demonstrating limited efforts to measure quality and set performance standards. Although a number of Member States are increasingly introducing more formalised quality measurement and assurance programmes and policies, many are in the initial stages of implementation. To guide these new and future efforts toward effective quality measurement, further research is needed to improve quality measures and data collection processes. Several actions to enhance the accuracy and completeness of data collection activities could be undertaken, such as better training of facility staff on good patient assessment practices, further exploration of the information needs of consumers and purchasers, and how such information is actually employed to make decisions. More broadly, long-term care should be better coordinated with acute health services to ensure a consistent continuum of care for older persons. A focus on coordination should be extended to the various entities involved in quality improvement initiatives