Enhancing care quality and safety for (older) adults with long term support needs: A review of quality and safety indicators
Notice bibliographique
Résumé
Introduction: The global healthcare landscape faces considerable challenges due to the changing population and rise of chronic conditions. These challenges have led to fragmented healthcare services, unaligned care provision, and reduced quality. The World Health Organization (WHO) advocates for a shift towards integrated, people-centred health services that enhance value-based healthcare by reducing fragmentation, improving care quality, and controlling costs. Integrated care (IC) involves delivering comprehensive, multidimensional healthcare across the life course with coordinated multidisciplinary teams. However, despite its importance, standardized and validated instruments for measuring integrated care, especially quality and safety (Q&S) indicators, are scarce. Q&S indicators are measurable items related to outcomes, processes, or care structure and are crucial for assessing care quality. This systematic review seeks to identify and summarize the available Q&S indicators for IC in (older) adults, providing insights into the most valuable indicators for evaluating care quality. Methodology: A systematic literature review was conducted to identify valid Q&S indicators for IC in (older) adults. The methodological quality of these indicators was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, while following PRISMA guidelines. Our search, carried out on September 16, 2021 (with a re-evaluation on March 29, 2022), encompassed databases Medline, CINAHL, and Web of Science without language or date restrictions. Indicators were evaluated in domains like: 'Stakeholder involvement,' 'Scientific evidence,' and 'Additional evidence formulation and usage,' with scores above 50% indicating high quality. Compatibility with the WHO definition of IC and other criteria, including relevance, comprehensibility, measurability, and feasibility, was also assessed. Results: A systematic search yielded 1135 results, leading to the inclusion of 14 studies. Most studies were in the Netherlands, the USA, followed by Canada, and others from diverse countries. Target groups included older adults in residential care settings (7), persons with head and neck cancer (2), dementia (2), and other conditions (2). The 390 indicators covered different domains with an emphasis on 'coordination and continuity of care' (37%). Process indicators were most common (46%), followed by outcome (42%) and structure (12%). Methodological quality varied, with stakeholder engagement scoring the highest (86%). An additional selection round reduced indicators to 75 based on specific criteria. Discussion and conclusion : This study aimed to overview published Q&S indicators for IC in (older) adults. The systematic review found various indicators for assessing care quality but noted significant differences in content and quality. Indicators were often tailored to specific groups, limiting their generic applicability. The indicators showed mixed methodological quality, with weaknesses in 'scientific evidence' and 'purpose, relevance, and organizational context’. Prioritizing patient participation in integrated care evaluation is crucial. Existing QIs should be chosen over creating new ones and should be tested in different contexts. The ageing population and increasing chronic diseases challenge healthcare systems, necessitating innovative solutions. A consensus on the IC definition captured from various perspectives is essential. Clear frameworks, patient-centred approaches, and scientific research are vital for better implementation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,074 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,005 |
| Bibliométrie | 0,024 | 0,024 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».