Measuring the quality of urinary continence care in long-term care facilities: an analysis of outcome indicators.
BACKGROUND
the National Centre for Health Outcomes Development has produced outcome indicators for the assessment of quality of care in the management of urinary incontinence. Three measures relate to the management of older people in long-term care: the prevalence of incontinence, the use of indwelling catheters and clinical assessment rates.


OBJECTIVE
to evaluate the recommended outcome measures in clinical practice.


METHODS
participating centres included residential homes, nursing homes and long-stay wards. We sent a structured questionnaire to each centre for qualitative assessment of the acceptability of the outcome indicators. We analysed data collected by nurses and other staff who used the urinary incontinence section of the Royal College of Physicians Continuous Assessment Review and Evaluation scheme audit tool for long-term care.


RESULTS
there were 1125 residents in 17 residential homes, 14 nursing homes and five long-stay wards. The overall prevalence of urinary incontinence was 34% in residential homes (range 2-86%), 70% in nursing homes (38-100%) and 71% in long-stay wards (4-97%). Catheterization rates were 5% in residential homes (0-20%), 10% in nursing homes (0-44%) and 6% in long-stay wards (0-20%). Rates of full clinical assessment were 48, 24 and 36% respectively.


CONCLUSIONS
there is great variability in these outcome measures within and between settings. Interpretation of outcome results requires more precise details on case-mix and the definition of outcome measures. Individual units found the audit tool helpful, but we advise caution with interpretation of outcomes between units.
Georgiou
A
A
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, UK. andrew.georgiou@rcplondon.ac.uk
Potter
J
J
Brocklehurst
J C
JC
Lowe
D
D
Pearson
M
M
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000628:therapy