Quality indicators for community care for older people: A systematic review

Karlijn J Joling; Liza van Eenoo; Davide L Vetrano; Veerle R Smaardijk; Anja Declercq; Graziano Onder; Hein P J van Hout; Henriëtte G van der Roest

doi:10.1371/journal.pone.0190298

Quality indicators for community care for older people: A systematic review

PLoS One. 2018 Jan 9;13(1):e0190298. doi: 10.1371/journal.pone.0190298. eCollection 2018.

Authors

Karlijn J Joling¹, Liza van Eenoo², Davide L Vetrano^{3

4

5}, Veerle R Smaardijk¹, Anja Declercq², Graziano Onder³, Hein P J van Hout¹, Henriëtte G van der Roest¹

Affiliations

¹ Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
² LUCAS, KU Leuven, University of Leuven, Leuven, Belgium.
³ Department of Geriatrics, Centro Medicina dell'Invecchiamento, Universita`Cattolica Sacro Cuore, Rome, Italy.
⁴ Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
⁵ Stockholm University, Stockholm, Sweden.

Abstract

Background: Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.

Methods: Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.

Results: Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain 'Additional evidence, formulation and usage' (51%), followed by 'Scientific evidence' (39%) and 'Stakeholder involvement' (28%).

Conclusion: A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes. PROSPERO Registration: 2014:CRD42014007199.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Community Health Services / standards*
Health Services for the Aged / standards*
Humans
Quality Indicators, Health Care*

Grants and funding

This study was conducted within the IBenC project (Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care) (FP7, grant no. 305912). The IBenC project was supported by the Seventh Framework Programme (CORDIS FP7) of the European Commission, 30 HEALTH (FP7-HEALTH-2012). The contents of this article reflect only the authors’ views and the European Commission is not liable for any use that may be made of the information contained therein. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.