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2012 Conference Presentation

(Inter)national systemsOutcomes and quality OECD

6 September 2012

Monitoring and improving quality in long-term care systems

Yuki Murakami, OECD, France
Francesca Colombo, OECD, France


Ensuring and improving quality of long-term care (LTC) services was ranked as the second most important policy priority (after ensuring fiscal and financial sustainability) across the 28 OECD countries in 2010. Indeed, several countries have implemented policies to achieve better quality LTC services and improve accountability over the past five years. LTC services can have a huge impact on the health and functional status of persons with physical or cognitive limitations. Good quality care can go a long way to improve their sense of autonomy as well as ability to take part in society, and thereby improve quality of life, despite their existing conditions.

However, stories about poor quality of LTC services and LTC users’ satisfaction surveys point to poor quality of care and instances of ‘substandard’ care in nursing homes, assisted living or home care services. The presentation will show preliminary results from a review of policies and indicators on quality in LTC across a selection of OECD countries. It will discuss policy initiatives across OECD countries, ranging from policies to regulate inputs, those aimed at standardising processes, to initiatives to drive continuous improvements in LTC systems and services. It will provide an overview of data and indicators used to monitor LTC quality across a selection of OECD countries, such as the prevalence of pressure ulcers (i.e. bedsores) and falls resulted in hospitalizations. The project will build upon previous work undertaken by the OECD on long-term care.

Preliminary results suggest that countries have traditionally approached the problem of quality through the regulatory process such as enforcing standards and requiring auditing, but the degree of compliance and enforcement vary and there are very different approaches to regulate home care providers and services. Some countries have collected administrative data to monitor quality at regular basis, although most of the available data are from nursing homes, and a few have developed indicators to measure care outcomes at the national level. These data are often used as part of public reporting with the objective of increasing transparency and providing choice to users. Some interesting initiatives can be found, for example, integrating information system to improve fragmentation of care process and information transfer and pay for performance schemes to reward providers with good outcome.


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