2015年-CEPS欧洲政策研究中心_Quality_Assurance_Indicators_of_Long_128页_884kb

Summary of "Quality Assurance Indicators of Long-Term Care in European Countries"

Core Content

This ENEPRI research report, authored by Roberto Dandi and Georgia Casanova, presents a comprehensive classification of quality assurance indicators for long-term care (LTC) across 11 European countries. The report is part of the ANCIEN project, which aims to explore the future of LTC for the elderly in Europe, funded by the European Commission under FP7.

The study categorizes quality indicators according to three dimensions: organisation type, quality dimensions, and system dimensions. These dimensions help in systematically evaluating the quality of LTC services.

Organisation Types

• Formal Institutional Care (FIC)
• Formal Home-Based Care (FHBC)
• Formal Home Nursing Care (FHNC)
• Informal Home Care (IHC)

Quality Dimensions

• Effectiveness: Refers to the extent to which care interventions achieve the intended outcomes.
• Safety: Ensures that care processes avoid, prevent, and mitigate harm.
• Patient Value Responsiveness: Captures the patient's perspective on care, including satisfaction, acceptability, and their personal values and preferences.
• Coordination: Involves the integration and continuity of care across different providers and systems.

System Dimensions

• Input: Includes physical structures, facilities, and resources.
• Process: Refers to the implementation of care services.
• Outcome: Measures the impact of LTC on the health and well-being of individuals and populations.

Main Contributions

The report collected a total of 390 quality indicators from 11 European countries, including Estonia, Finland, France, Germany, Hungary, Italy, Latvia, the Netherlands, Spain, Sweden, and the United Kingdom. These indicators are used at the national level or are recommended for local implementation by national authorities.

Each indicator is classified according to the three dimensions, with some indicators spanning multiple categories. For example, in the UK, the indicator "Business premises, management and planning" is classified under both input and process.

Key Findings

Organisation Type Distribution

• FIC indicators are most prevalent across all countries.
• FHBC and FHNC have fewer indicators, with IHC being the least addressed, except in the UK and Spain.

Quality Dimension Focus

• Effectiveness is the most commonly addressed quality dimension.
• Safety is the least prioritized, with only a few countries (Germany, France, UK, etc.) having indicators related to it.
• Responsiveness and Coordination are also significant, though less so than effectiveness.

System Dimension Distribution

• Process indicators dominate the system dimension classification.
• Outcome indicators are rare in most countries, except the Netherlands, Slovakia, and Sweden.
• Input indicators are also present but less numerous than process indicators.

Country-Specific Insights

• France has a balanced distribution of indicators, with a focus on voluntary quality standards.
• Germany has a robust system of external inspections and transparency reports.
• UK and Spain are the only countries that include indicators for informal home care.
• Italy, Slovakia, and Hungary have the fewest quality indicators, with limited focus on safety and outcome indicators.
• The Netherlands and Sweden show a more comprehensive approach to outcome indicators, which are considered more informative but challenging to collect.

Conclusion

The report highlights significant variation in the development and use of quality assurance indicators across European countries. While most countries have developed indicators for formal LTC, informal care remains underrepresented. Safety and outcome indicators are less common, suggesting a need for greater attention to these aspects in future quality initiatives. The study underscores the importance of a balanced approach that includes all three dimensions—organisation type, quality dimensions, and system dimensions—to ensure a holistic view of LTC quality.

References

• Donabedian, A. (1985). The validity of quality indicators.
• Shaw, M. & Kalo, K. (2002). Quality in long-term care.
• WHO (2000, 2002). Definitions and frameworks for care responsiveness and home-based care.

Figures and Tables

• Figure 1.1: Donabedian's model of quality indicators.
• Figure 1.2: Distribution of quality indicators by organisation type.
• Figure 1.3: Distribution of quality indicators by quality dimension.
• Figure 1.4: Distribution of quality indicators by system dimension.
• Table 1.1: Quality indicators by organisation type.
• Table 1.2: Quality indicators by quality dimension.
• Table 1.3: Quality indicators by system dimension.
• Table 1.4: Contingency matrix of quality indicators.
• Table 1.5: Outcome indicators across countries.