Identification of Quality Indicators Used to Monitor, Evaluate and Improve Rural and Remote Care for Older People: A Scoping Review

Objective: Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings.

Methods: Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised.

Findings: Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (n = 28, 54%), accessibility (n = 11, 21%), resources (n = 9, 17%), and hospital readmissions (n = 4, 8%). Most QIs were outcome (n = 25, 48%) or process (n = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas.

Conclusions: Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare.