Quality of care in nursing homes in Tuscany: feasibility, accuracy and portability of a monitoring system

Description of the problem We have carried on a research to evaluate the feasibility, accuracy and portability of a system for monitoring the quality of services measured by a set of process and outcome indicators. Sixty-seven Tuscan NHs, including 2,801 elderly residents, voluntarily participated a larger ministerial cross sectional study during the period 2010 - 2013. After a literature review, a selection of 46 priority indicators were considered. Indicators regarded 9 thematic areas: pressure ulcers, falls, pain, urinary incontinence, contentions, cognitive and functional decline, disease exacerbations, malnutrition and inappropriate prescribing. The indicators were calculated through routinary administrative health database and ad hoc surveys. Results The 10 ‘‘inappropriate prescribing’’ indicators were calculated with good accuracy and feasibility, by using a routinary administrative database, also enabling a comparative analysis of pre and post-admission healthcare status of elderly NHs residents. On the contrary, since the database provides incomplete data, the 4 ‘‘cognitive and functional decline’’ indicators were not computable. As a surrogate, we compared the results of cognitive (Short Physical Performance Battery) and functional (Barthel index) surveys previously performed. For the remaining 32 indicators, two ad-hoc surveys were performed to verify their feasibility and effectiveness in measuring the quality of care. Lessons All the proposed indicators were calculated with different degrees of difficulty, identifying critical areas for the quality and the planning of care in NHs. At present, either in the regional or national context, the system of monitoring the quality of services is heterogeneous and a coordinated technological network is absent. Therefore, it is mandatory to implement a monitoring system that could integrate accreditation requirements and process and outcome indicators through a systematic and shared survey system. Key message Nowadays a homogeneous system of monitoring of quality of care is absent. Our study shows it is possible to identify and share indicators for monitoring the quality of care in nursing homes.