Monitoring cross-setting care and outcomes among older people in aged care: a national framework is needed
Maria C. Inacio A B * , Olivia Ryan
A , Leonard C. Gray C , Gillian E. Caughey A B and on behalf of the ACAC-QMET Research Collaborators §
A
B
C
Abstract
Establishing an evidence-based framework to monitor and evaluate quality and safety of care for older people is critical. Despite progress in health system performance monitoring in Australia, slower progress has occurred for the older population accessing aged care services. With an aging population and increasing demands on aged care and healthcare systems, there is growing recognition of the need for more coordinated and integrated care across settings. It is not uncommon for older people accessing aged care to require a range of services administered by different organisations simultaneously (e.g. primary care, home care) and sequentially (e.g. hospitals, residential care). Aged care also represents an increasingly regulated sector, with significant investment in and growing recognition of the value of quality measurement. Accountability for care quality and safety is often shared among providers, with consequent challenges in attributing responsibility. Therefore, the development of a pragmatic national framework to support high-quality, person-centred care for the older population accessing aged care services across care settings is one opportunity for shared responsibility, care monitoring, and quality improvement activities that could lead to better outcomes for this population. The strategy for framework development proposed in this perspective has implications for aged care and healthcare providers, consumers, policy makers, regulators, and academics. Once implemented, this framework has the potential to drive consistent high-quality care to improve health outcomes and wellbeing among older people accessing aged care services.
Keywords: framework, long-term care, quality of care, quality measurement.
References
1 Berwick D. Era 3 for Medicine and Health Care. JAMA 2016; 315: 1329-30.
| Crossref | Google Scholar | PubMed |
2 Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163(9): 458-71.
| Crossref | Google Scholar | PubMed |
3 Australian Commission on Safety and Quality in Health Care. The state of patient safety and quality in Australian hospitals 2019. Sydney: ACSQHC; 2019. Available at https://www.safetyandquality.gov.au/sites/default/files/2019-07/the-state-of-patient-safety-and-quality-in-australian-hospitals-2019.pdf [accessed 20 May 2024].
4 Braithwaite J, Hibbert P, Blakely B, et al. Health system frameworks and performance indicators in eight countries: A comparative international analysis. SAGE Open Med 2017; 5: 2050312116686516.
| Crossref | Google Scholar | PubMed |
5 Sutherland K, Levesque JF. Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. J Eval Clin Pract 2020; 26: 687-96.
| Crossref | Google Scholar | PubMed |
6 Australian Institute of Health and Welfare Metadata Online Registry. Australian Health Performance Framework. Canberra: Australian Institute of Health and Welfare; 2024. Available at https://meteor.aihw.gov.au/content/721590 [accessed 26 August 2024].
7 Hurst J J-HM. Performance Measurement and Performance Management in OECD Health Systems. OECD Publishing Paris; 2001. Available at https://www.oecd.org/en/publications/performance-measurement-and-performance-management-in-oecd-health-systems_788224073713.html [accessed 19 June 2024].
8 Canaway R, Bismark M, Dunt D, et al. Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study. BMC Health Serv Res 2017; 17: 391.
| Crossref | Google Scholar | PubMed |
9 Australian Government Department of Health and Aged Care. 2023–24 Report on the Operation of the Aged Care Act 1997. Canberra: Department of Health and Aged Care; 2024. Available at https://www.gen-agedcaredata.gov.au/getmedia/14364e69-0e14-44c1-b84f-e12884f9921a/Health-and-Aged-Care-ROACA23-24_WEB.pdf [accessed 10 January 2025].
10 The Hon Mark Butler MP Minister for Health and Aged Care. Building a stronger Medicare. Canberra; 2023. Available at https://www.health.gov.au/sites/default/files/2023-05/stakeholder-pack-budget-2023-24.pdf [accessed 18 June 2024].
11 Australian Institute of Health and Welfare. Australia’s welfare 2023 data insights. Canberra: AIHW; 2023. Available at https://www.aihw.gov.au/reports/australias-welfare/australias-welfare-2023-data-insights/contents/measuring-quality-in-aged-care [accessed 19 June 2024].
12 Carnell K, Paterson R. Review of National Aged Care Quality Regulatory Processes Report. Australian Government Department of Health and Aged Care; 2017. Available at https://www.health.gov.au/sites/default/files/review-of-national-aged-care-quality-regulatory-processes-report.pdf [accessed 23 May 2024].
13 Department of Health and Aged Care. Star Ratings for Residential Aged Care. 2022. Available at https://www.health.gov.au/sites/default/files/documents/2022/11/star-ratings-summary-report_0.pdf [accessed 18 June 2024].
14 Australian Government Department of Health and Aged Care. Reporting for Home Care Packages. 2024. Available at https://www.health.gov.au/our-work/hcp/responsibilities/reporting [accessed 21 October 2024].
15 Steering Committee for the Review of Commonwealth/State Service Provision Industry Commission. Report on Government Services 1997. Melbourne: Productivity Commission; 1997. Available at https://www.pc.gov.au/ongoing/report-on-government-services/1997/1997/chapter07.pdf [accessed 17 January 2025].
16 Steering Committee for the Review of Government Service Provision. Report on Government Services 2024, Community services (Part F). Canberra: Productivity Commission; 2024. Available at https://www.pc.gov.au/ongoing/report-on-government-services/2024/community-services/aged-care-services [accessed 17 January 2025].
17 Rayner JA, Fetherstonhaugh D, McAuliffe L. Public health service board members’ understanding of care quality in residential aged care services. Aust Health Rev 2023; 47: 427-32.
| Crossref | Google Scholar | PubMed |
18 Inacio MC, Lang C, Caughey GE, et al. The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care. Int J Qual Health Care 2020; 32(8): 502-10.
| Crossref | Google Scholar | PubMed |
19 Caughey GE, Lang CE, Bray SC, et al. International and National Quality and Safety Indicators for Aged Care. Report for the Royal Commission into Aged Care Quality and Safety. Research Paper 8. South Australian Health and Medical Research Institute; 2020. Available at https://nla.gov.au/nla.obj-2924408596/view [accessed 19 June 2024].
20 Hibbert PD, Molloy CJ, Cameron ID, et al. The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study). BMC Med 2024; 22(1): 22.
| Crossref | Google Scholar | PubMed |
21 Inacio MC, Eshetie TC, Caughey GE, et al. Quality and safety in residential aged care: an evaluation of a national quality indicator programme. Intern Med J 2023; 53: 2073-8.
| Crossref | Google Scholar | PubMed |
22 Chatburn E, Macrae C, Carthey J, et al. Measurement and monitoring of safety: impact and challenges of putting a conceptual framework into practice. BMJ Qual Saf 2018; 27(10): 818-26.
| Crossref | Google Scholar | PubMed |
23 Carthey J. Measurement and Monitoring of Safety Framework (MMSF): learning from its implementation in Canada. BMJ Qual Saf 2023; 32(8): 441-3.
| Crossref | Google Scholar | PubMed |
24 Inacio MC, Lang C, Bray SCE, et al. Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort. Intern Med J 2021; 51: 712-24.
| Crossref | Google Scholar | PubMed |
25 Amare AT, Caughey GE, Whitehead C, et al. The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services. Aust N Z J Psychiatry 2020; 54(12): 1200-11.
| Crossref | Google Scholar | PubMed |
26 Australian Commission on Safety and Quality in Health Care. Transitions of Care. Sydney: ACSQHC; 2024. Available at https://www.safetyandquality.gov.au/our-work/transitions-care [accessed 18 September 2024].
27 Australian Commission on Safety and Quality in Health Care. Safety Issues at Transitions of Care: Consultation report on pain points relating to clinical information systems. Sydney: ACSQHC; 2017. Available at https://www.safetyandquality.gov.au/our-work/e-health-safety/safety-issues-transitions-care-pain-points-relating-clinical-systems [accessed 18 September 2024].
28 Jacobs DB, Schreiber M, Seshamani M, et al. Aligning Quality Measures across CMS - The Universal Foundation. N Engl J Med 2023; 388: 776-79.
| Crossref | Google Scholar | PubMed |
29 MacLean CH, Kerr EA, Qaseem A. Time Out - Charting a Path for Improving Performance Measurement. N Engl J Med 2018; 378: 1757-61.
| Crossref | Google Scholar | PubMed |
30 Kelley E, Hurst J. Health Care Quality Indicators Project: Conceptual Framework Paper. OECD Health Working Papers No. 23; 2006. Available at https://read.oecd-ilibrary.org/social-issues-migration-health/health-care-quality-indicators-project_440134737301 [accessed 23 May 2024].
31 Carinci F, Van Gool K, Mainz J, et al. Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators. Int J Qual Health Care 2015; 27: 137-46.
| Crossref | Google Scholar | PubMed |
32 Australian Government Australian Institute of Health and Welfare. Mental health - Performance indicators. Canberra: AIHW; 2024. Available at https://www.aihw.gov.au/mental-health/monitoring/performance-indicators [accessed 21 February 2025].
33 Australian Government Australian Institute of Health and Welfare. Development of the National Palliative Care Measures. Canberra: AIHW; 2024. Available at https://www.aihw.gov.au/getmedia/0ecbb5b1-4f83-4706-85ef-b0852318b7df/aihw-hse254-development-of-the-national-palliative-care-measures.pdf [accessed 21 February 2025].
35 Dendere R, Hargrave M, Ferris J, et al. A compelling case for the development and adoption of data standards and interoperability in the Australian aged care sector. Centre for Health Services Research: The University of Queensland Australia; 2021. Available at https://chsr.centre.uq.edu.au/files/7042/A-compelling-case-for-the-development-and-adoption-of-data-standards-and-interoperability-in-the-Australian-aged-care-sector_White-Paper.pdf [accessed 23 May 2024].
36 Kim H, Jeon B. Developing a framework for performance assessment of the public long-term care system in Korea: methodological and policy lessons. Health Res Policy Syst 2020; 18(1): 27.
| Crossref | Google Scholar | PubMed |
37 Nies H, Leichsenring K, van der Veen R, et al. Quality Management and Quality Assurance in Long-Term Care, European Overview Paper. Utrecht/Vienna; 2010. Available at https://www.euro.centre.org/downloads/detail/767 [accessed 23 May 2024].
38 Osińska M, Favez L, Zúñiga F. Evidence for publicly reported quality indicators in residential long-term care: a systematic review. BMC Health Serv Res 2022; 22(1): 1408.
| Crossref | Google Scholar | PubMed |
39 Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Intern Med J 2012; 42: 569-74.
| Crossref | Google Scholar | PubMed |
