Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs)

Abstract

Background: Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales.

Methods: Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology.

Results: A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark.

Conclusions: The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

Fig. 1

Functional Quality Indicators - average proportions of individuals declining or improving, European home care clients, N = 1354. Abbreviations: ADL = activities of daily living; IADL = instrumental activities of daily living; QI = quality indicator

Fig. 2

Clinical Quality Indicators – average proportions of individuals declining or improving, European home care clients, N = 1354. Abbreviations: QI = quality indicator

Fig. 3

Social and Service Clinical Quality Indicators – average proportions of individuals declining or improving at 6-month follow-up, European home care clients, N = 1354. Abbreviations: ER = emergency room; QI = quality indicator

Fig. 4

Scores by Country, interRAI Home Care Clinical Balance Scale and interRAI Home Care Independence Quality Scale, N = 1354