Abstract

Background: In Italy, public long-term care (LTC) for older people comprises three main sources of formal assistance: home care (HC), residential care (with nursing home – NH) and cash allowances. On average 5n 2006 in Italy 3.6% of elderly, that were about 20% of the total population, received the Integrated HC service while the coverage of NH services was 3%. The different regions are characterized by a great fragmentation and lack of homogeneity as regards the institutional, organizational and financial aspects, as well as the offer of services and the use of evaluation tools. Such diversity can affect the quality and equity of the services provided, as well as the health and the quality of life of elderly patients and their family members. National indicators to evaluate the LTC system often relate to the services coverage on elderly population and a good performance is associated with high levels of population coverage for both HC and NH compared to the Italian average. The aim of the paper is to present dimensions of evaluation and performance indicators for NH in Tuscany Region (Italy) in which there are totally 300 NH with 11.700 hospital beds.

Methods: Since 2004 Tuscany Region has been adopting a performance evaluation system (PES) for the whole health care system (12 Local Health Authorities and 4 Teaching Hospitals). In 2012 Tuscany Region, started, with voluntary 80 NH, a process to evaluate NH quality performances and variability. This process consisted of two main stage: the map of NH organizations and services in order to develop a benchmarking context in which compare properly quality, equity and efficiency; the development of a systematic PES. During a 3-week training and research course, NH managers and health operators, divided in three heterogeneous groups, were invited to define a set of indicators to evaluate NH performance in a multidimensional way. Results of single group were shared in plenary sessions through a Delphi method.

Results and conclusions: Participants identified four different quality dimensions and relative performance indicators based on administrative data flows and patients and staff survey. The evaluation dimensions are the following: quality of clinical care, quality of integration and daily activities, patients and family satisfaction, staff satisfaction and financial efficiency; these dimensions are monitored by about 30 performance indicators (tested in the 80 NH) that are evaluated on the basis of the regional average or on minimum quality standards to achieve. The PES it’s characterized by a public reporting system, multidimensionality, transparency and accountability, which aim to make NH responsible for their actions and use of resources and, even if it is in his early stage of development, it is acting as a stimulant for quality improvement. This regional evaluation process had stimulated a good debate between NH operators, improving their managerial capacity and data and benchmarking culture in order to improve overall quality. The PES in fact can be a tool not only for the region, but also for family and patients so to increase the equity of the LTC system.

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