Evidence for publicly reported quality indicators in residential long-term care: a systematic review

Abstract

Background An increasing number of countries are using or planning to use quality indicators (QIs) in residential long-term care. Knowledge regarding the current state of evidence on usage and methodological soundness of publicly reported clinical indicators of quality in nursing homes is needed. The study aimed to answer the questions: 1) Which health-related QIs for residents in long-term care are currently publicly reported internationally? and 2) What is the methodological quality of these indicators? Methods A systematic search was conducted in the electronic databases PubMed, CINAHL and Embase in October 2019 and last updated on August 31st, 2022. Grey literature was also searched. We used the Appraisal of Indicators through Research and Evaluation (AIRE) instrument for the methodological quality assessment of the identified QIs. Results Of 23′344 identified records, 22 articles and one report describing 21 studies met the inclusion criteria. Additionally, we found 17 websites publishing information on QIs. We identified eight countries publicly reporting a total of 99 health-related QIs covering 31 themes. Each country used between six and 31 QIs. The most frequently reported indicators were pressure ulcers, falls, physical restraints, and weight loss. For most QI sets, we found basic information regarding e.g., purpose, definition of the indicators, risk-adjustment, and stakeholders’ involvement in QIs’ selection. Little up to date information was found regarding validity, reliability and discriminative power of the QIs. Only the Australian indicator set reached high methodological quality, defined as scores of 50% or higher in all four AIRE instrument domains. Conclusions Little information is available to the public and researchers for the evaluation of a large number of publicly reported QIs in the residential long-term care sector. Better reporting is needed on the methodological quality of QIs in this setting, whether they are meant for internal quality improvement or provider comparison.

Clinical pharmacy key performance indicators for hospital inpatient setting: a systematic review

“…Two items were poorly scored: evidence supporting the KPIs and the lack of piloting and post-development evaluation. Our findings align with previous analyses in areas such as school feeding programs [ 23 ], long-term care [ 26 ], or dental care [ 24 ]. Higher scores in domain #1 (Purpose, relevance, and context) suggest that KPI developers have a clear vision of their objectives.…”

“…AIRE, a validated instrument designed for indicator quality assessment [ 21 ], was initially derived from the AGREE (Appraisal of Guidelines Through Research and Evaluation) instrument [ 22 ]. Utilized in several systematic reviews on indicator quality [ 23 – 26 ], the AIRE instrument comprises 20 items across four domains: "Purpose, relevance, and organizational context," "Stakeholder involvement," "Scientific evidence," and "Additional evidence, formulation, and usage." Each item presents a statement about the quality of the indicator and is scored on a 4-point scale (1 ‘totally disagree or no information provided’ to 4 ‘strongly agree’).…”

Key performance indicators for pharmaceutical services: A systematic review

“…Other reviews also revealed poor reporting of the methods used for developing quality indicators that complicated the assessment of the methodological rigor and quality of the studies. 57 , 58 , 59 It is important to highlight that there was no disparity in quality assessment between studies that developed a set of KPIs solely for clinical services compared to those that incorporated support activities.…”

Quality Indicators for Residential Long-Term Care for the Elderly: A Scoping Review

“…(2021) that analyze the development of quality indicators for dementia care. A recent systematic review (Osińska et al, 2022) analyzed the quality indicators in residential long-term care, specifically those employed for public reporting.…”