2012年-CEPS欧洲政策研究中心_Quality_Assurance_Policies_and_Indicators_for_Long_12页_191kb

Summary of Quality Assurance Policies and Indicators for Long-Term Care in Estonia

Core Content

This report provides an overview of the quality assurance policies and indicators for long-term care (LTC) in Estonia, as part of the ANCIEN project, which aims to assess the future of LTC for the elderly in Europe. The focus is on the organisational structure, legal frameworks, and current status of quality assurance in both health and social care sectors.

Main Responsibilities and Organisational Structure

• Ministry of Social Affairs (MOSA) is the main body responsible for the development and control of LTC quality at the national level.
• Health Board (HB) oversees the quality of health professionals and ensures compliance with health service standards.
• Estonian Health Insurance Fund (EHIF) is responsible for financing and monitoring the quality of health services, including LTC.
• County governors represent the government in 15 counties and are tasked with monitoring primary health care and social services.
• Local municipalities are the primary providers of social services, with a responsibility to develop their own social welfare plans.

Policies and Regulations in LTC

• Legal Framework: Quality assurance in LTC is primarily based on the Social Welfare Act and the Health Services Organisation Act.
• Quality Handbook: All health service providers must have a Quality Handbook, which serves as the basis for internal QA systems.
• Minimum Standards: The Regulation of hospital standards outlines minimum infrastructure and equipment requirements for nursing hospitals, including mandatory devices, staffing, and room specifications.
• Professional Qualifications: Professional standards for social care workers, nurse assistants, and nurse practitioners are developed by the Estonian Qualifications Authority.
• Education and Training: Education and training for LTC professionals are managed by various institutions, with Tartu University being the main provider of medical education and training for care managers and health professionals.

Monitoring and Evaluation

• Monitoring Focus: Currently, quality monitoring in Estonia is based on 'hard criteria' such as infrastructure and resources, with limited focus on process and outcome evaluation.
• Health Board Monitoring: HB conducts regular audits and assessments of health services, including nursing hospitals, using tools like CareKeys - MAssT and Institutionalised Care key indicators.
• County Governor Reports: County governors are required to submit supervision reports to MOSA, but compliance is low (only 20% in 2009).
• Publicity of Data: There is currently no public availability of quality indicators or audit results, despite the existence of national and local development plans aiming to improve this in the future.

Quality Indicators

• No Measured Indicators: At present, no national or local-level quality indicators are measured in Estonia.
• Proposed Indicators:
  • Share of supervisory reports provided in social care: 20% in 2009, with a target of 100% by 2014.
  • Share of social services covered by service guidelines: 0% currently, with a target of 50% by 2014.
• Patient Satisfaction Survey: Annual surveys have been conducted since 1999, but specific LTC quality indicators are not included in the data.

EBM Guidelines and Standards

• Clinical Guidelines: The EHIF supports the development of clinical guidelines, with 37 officially approved and over 50 more prepared by medical specialties.
• Nursing Care Guidelines: Two sets of practical guidelines for nursing care and home nursing care have been developed, but no specific quality indicators are currently used.
• International Standards: There is potential to adopt internationally recognised LTC indicators, such as interRAI, to improve quality assessment.

Policies for Informal Care

• Informal Care Support: There are no specific policies for informal care, but general support for flexible employment and economic development is included in national policy documents.
• EU Structural Funds: These are used to support activities that improve the efficiency and quality of home-based services, particularly for informal carers.

Future Plans

• Improvement of Monitoring: The development of routine monitoring and the publication of quality results are planned for the near future.
• Quality Databases: Plans include the improvement and publication of quality-related databases to help patients find best practices.
• Integration of Quality Indicators: The national and local development plans aim to incorporate more quality indicators in the future, improving transparency and accountability in LTC services.

Conclusion

Estonia has made progress in establishing quality assurance frameworks for LTC, particularly in health services, but there is a lack of comprehensive quality indicators and evaluation of outcomes. The country is moving towards more structured monitoring and the use of quality guidelines, but the implementation remains uneven and limited. Future developments are expected to include the adoption of international LTC indicators and improved transparency in quality monitoring.