2015年-CEPS欧洲政策研究中心_Long_89页_939kb

Summary of Long-Term Care Quality Assurance Policies in European Countries

Core Content

This report, part of the ANCIEN project, provides an in-depth analysis of long-term care (LTC) quality assurance policies across 15 European countries: Austria, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Poland, Slovakia, Slovenia, Spain, Sweden, the Netherlands, and the United Kingdom. It outlines the dimensions of LTC quality, the frameworks for assessing quality, and the various levels of quality management (international, national, organisational, and user levels). The report also identifies four clusters of countries based on their LTC quality policies and indicators, and offers policy recommendations.

Main Viewpoints

1. Definition of LTC Quality

• LTC quality is defined as the degree to which services increase the likelihood of desired health outcomes and align with current professional knowledge.
• Unlike acute care, LTC is a mix of health and social services, aiming to improve quality of life, autonomy, and dignity.
• LTC is characterized by its long-term, non-specialized, and labor-intensive nature, often provided by paraprofessionals and informal caregivers.

2. Dimensions of LTC Quality

• The report identifies 12 key dimensions of LTC quality, grouped into three main categories:
  • Effectiveness: Measuring the success of interventions in improving health and functional status.
  • Safety: Ensuring that care processes avoid or minimize harm to patients.
  • Responsiveness: Reflecting how well care meets patient preferences and non-health expectations.
• Other dimensions include Accessibility, Equity, Efficiency, Acceptability, Appropriateness, Competence, Continuity, and Timeliness.
• The OECD framework reduces these to three main dimensions: Effectiveness, Safety, and Responsiveness / Patient Centeredness.

3. Assessment of LTC Quality

• Input indicators measure the presence or absence of resources (e.g., staffing ratios, infrastructure, and qualifications).
• Process indicators evaluate how care is delivered (e.g., resident assessments, care management procedures).
• Outcome indicators assess the health and functional status of patients or their satisfaction with care.
• Outcome-Based Quality Indicators (OBQI) are particularly useful for evaluating the effectiveness of LTC but have limitations in reliability and validity due to the complex nature of LTC and the lag time between interventions and outcomes.
• The Resource Utilisation Groups (RUG) is a common case-mix measurement used in LTC.

4. Quality of Life in LTC

• Quality of life in LTC is a multidimensional concept that includes both performance outcomes (e.g., physical well-being, clinical status) and value outcomes (e.g., emotional well-being, social inclusion).
• It is influenced by the environment, care coordination, and the availability of personal assistance services.
• The Schalock framework (2001, 2004) highlights the importance of measuring both individual and organizational performance and values.

5. Levels of Quality Management in LTC

• Nies et al. (2010) identified four levels at which LTC quality can be addressed:
  • International level: Recommendations, guidelines, and funding from organizations like the EU and WHO.
  • System level: Legislation, inspectorates, accreditation, and certification.
  • Organisational level: Quality management systems, audits, monitoring, and benchmarking.
  • Professional level: Training, new roles, professional accreditation, and communication tools.
  • User level: Informed consent, choice, satisfaction, and information about care quality.

Key Information

• EU Vision for LTC Quality:

  • Member states are committed to ensuring accessible, high-quality, and sustainable LTC.
  • Policies focus on improving quality standards, monitoring systems, care coordination, and patient involvement and choice.
  • The EU emphasizes the development of quality standards that reflect international best practices and strengthens the responsibility of both health professionals and care recipients.

• Challenges in Quality Assessment:

  • Differences in definitions and classifications of LTC across countries make cross-country comparisons difficult.
  • The complexity of LTC services and the lag time between care delivery and outcomes complicate the assessment of OBQI.
  • Quality indicators must be developed with scientific rigor and should reflect both structural, process, and outcome aspects of care.

• Data Collection and Analysis:

  • A survey was conducted to collect data on LTC quality policies and systems.
  • Country profiles were developed using survey data and texts from national partners.
  • The data were analyzed to cluster countries based on similarities in their quality policies and systems.

• Future Directions:

  • The report suggests the need for a more integrated approach to quality assessment that includes both performance and value outcomes.
  • It calls for the development of better monitoring systems and the use of self-reported data to complement outcome-based indicators.
  • Policy recommendations are proposed to enhance LTC quality across the EU.

Conclusion

The report highlights the importance of a comprehensive and multi-dimensional approach to LTC quality assurance, emphasizing the need to consider both clinical and social aspects of care. It also underscores the role of international guidelines and national policies in shaping LTC quality and the necessity of coordinated efforts at all levels—system, organizational, professional, and user—to ensure that LTC services meet the needs of individuals and populations in a sustainable and equitable manner.