Performance indicators on long-term care for older people in 43 high- and middle-income countries: literature review, web search and expert consultation.

Abstract

Background: Long-term care (LTC) for older people is an area of focus for many health and social policies in high- and middle-income countries. Performance Indicators are used to provide national and subnational jurisdictions with insights to ensure quality of the provided LTC services for older people. Although LTC systems vary across jurisdictions, there is demand for internationally comparable indicators to support countries in monitoring LTC and facilitate mutual learning. The aim of this study was to provide an overview of indicators currently employed to monitor the performance of LTC systems and services in high- and middle- income countries and describe their key characteristics.

Methods: A review of the literature in six scientific databases (literature review) and web searches of relevant sites across 43 selected countries (web search) was conducted. We asked country representatives from the Working Party on Health Care Quality and Outcomes of the Organization for Economic Cooperation and Development, where most of these countries are represented, to cross-validate the sources of information found (expert consultation). We then extracted and analysed the data from all obtained sources based on a predetermined set of characteristics.

Results: The search of scientific databases yielded 12,960 records, from which forty papers were selected for inclusion. The scientific literature findings were complemented by 34 grey literature sources. In total, we identified performance indicators being used to monitor LTC systems and services across 29 national and subnational jurisdictions in 24 out of 43 countries. In total, 620 indicators were identified. All jurisdictions used indicators related to institutional LTC and 16 also used indicators on home care. The most frequently monitored structures, processes, and results were pressure ulcers, falls, use of restraints and pain management.

Conclusions: We identified LTC performance indicators currently being monitored in 29 jurisdictions across 24 countries. Many jurisdictions are monitoring similar structures, processes, and results. This presents an opportunity to develop internationally comparable LTC performance indicators based on existing efforts across countries.