Quality Indicators to Monitor Care in Long-Term Care Facilities: A Scoping Review

Objective: To identify and synthesize quality indicators (QIs) used to routinely monitor and assess the quality and safety of care received by residents of long-term care facilities (LTCFs). Design: A scoping literature review. Setting and Participants: Older people aged ≥65 years residing in LTCFs. 

Methods: Academic and gray literature searches were done to identify publicly available QIs, routinely used at the population level and reported since 2012. QIs were synthesized by domain, QI type (structure, process, and outcome), and dimension of quality (efficiency, effectiveness, patient-centeredness, timeliness, equity, and safety). The data used to develop the QIs, risk adjustments, and population- and reporting-related characteristics were also summarized. 

Results: A total of 327 QIs from 18 programs across 13 countries were identified. Of the identified QIs, 68.2% (n = 223) were outcome QIs, 30.0% (n = 98) were process QIs, and 1.8% (n = 6) were structure QIs. Almost 80% (79.2%; n = 259) of the QIs were related to the dimensions of safety and effectiveness. The most common domains across the 18 QI programs included falls/fractures/injuries, medication-related, and pressure injury, with 14 programs (77.8%) covering each of these areas. Standardized clinical data (n = 235) was the most common data source used for QI estimation. Public reporting was available at various levels ranging from the national to facility level. 

Conclusions and Implications: International QIs to monitor and evaluate the quality of care in LTCFs focus on safe and effective care, essential in supporting residents to maintain well-being and quality of life. The findings from this review highlight the need for wider adoption of a comprehensive holistic suite of QIs to support person-centered care, reflective of all dimensions of care quality including equity, to drive improvements in LTCFs worldwide.