Developing quality indicators for older adults: transfer from the USA to the UK is feasible
- 1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
- 2Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 2SR, UK
- 3RAND Health, Santa Monica, CA 90407-2138, USA
- 4Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90095-1736, USA
- 5Department of Medicine for the Elderly, Addenbrooke’s NHS Trust, Cambridge CB2 2QQ, UK
- Correspondence to: Dr N Steel School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK; n.steeluea.ac.uk
- Accepted 23 May 2004
Abstract
Background: Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective healthcare interventions in both primary and secondary care.
Method: One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people.
Results: The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening.
Conclusions: These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.
Footnotes
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↵* Valid = median of >6 on a scale of 1–9 with no disagreement (disagreement defined as 3 or more ratings in the 1–3 region, together with 3 or more ratings in the 7–9 region).
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↵* Invalid = median 6 or less on a scale of 1–9, or median >6 with disagreement (disagreement defined as 3 or more ratings in the 1–3 region, together with 3 or more ratings in the 7–9 region).
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NS was supported by The Commonwealth Fund, a New York City based private independent foundation, and by the UK National Coordinating
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Centre for Research Capacity Development. The National Health Service Executive Eastern Region provided funding for the clinical panel meeting.
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This work was done at the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK
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The views presented here are those of the authors and not necessarily those of The Commonwealth Fund, its director, officers or staff.
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See editorial commentary, p 248
