Abstract

This presentation showcases the results of a mapping exercise of existing mechanisms for public reporting of quality in long-term care (LTC) in six European countries.

The exercise focused not only on compulsory mechanisms that are part of the general quality assurance framework, such as in England, Germany, and the Netherlands, but also on pilot and smaller scale reporting systems in Austria, Finland, and Spain. It also set out to collect and analyse information on the outcomes of public reporting and to compare them with the experiences in the United States, where research on the topic is well established. The mapping exercise critically describes public reporting mechanisms using existing secondary sources of information, supplemented by information and analyses from national experts.

To assess the outcomes of public reporting on quality in LTC we used Berwick and colleagues’ (2003) framework which identifies two pathways of impacting quality: firstly by supplying purchasers with information that allows them to choose providers of better quality – the ‘selection pathway’; and secondly by giving providers sufficient incentives for implementing change and improving quality – the ‘change pathway’.

Comparative analysis revealed that public reporting mechanisms are more likely to be implemented in the residential care sector, in part reflecting the greater difficulty in assessing quality in home care and other services. Many indicators which are publicly disclosed extend beyond indicators of quality of care, and include information on concepts related to the 'quality of life' of users, such as privacy, comfort, and participation in decision-making. The impact of public reporting on the behaviour of users and public purchasers remains limited, and may be linked to due to older peoples’ difficulties in accessing and processing information, especially as it is often provided via the internet, a medium which is often not accessed regularly by older people. The evidence that public reporting drives quality improvement in providers is contradictory in the United States, while in Europe, where systems are generally less well established, there has been limited research into this area.

However, the introduction of public reporting seems to have increased debate on the best ways to define and assess quality in LTC in some European countries. The findings of this exercise highlight that the establishment of public reporting has lagged behind the introduction of user choice mechanisms, such as vouchers or personal budgets. Similarly, there seems to be a disconnect between the ideal way in which decisions are made – using the Internet, affording time for weighting pros and cons of a multitude of complex indicators – and how it is done in reality. In the context of policies that aim to enhance user choice, greater attention and discussion should be given to the measurement and reporting of quality indicators, as well as to the creation of appropriate incentives to drive improvements in quality from providers.

Slides