title: The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems.
abstract: BACKGROUND
  Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted.
  
  
  METHODS
  The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion.
  
  
  RESULTS
  The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care.
  
  
  CONCLUSIONS
  Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.
authors.affiliation: Research Department of Mental Health Sciences, UCL Medical School, London, UK. h.killaspy@ucl.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
authors.forename: Sarah
authors.initials: S
authors.lastname: White
authors.forename: Christine
authors.initials: C
authors.lastname: Wright
authors.forename: Tatiana L
authors.initials: TL
authors.lastname: Taylor
authors.forename: Penny
authors.initials: P
authors.lastname: Turton
authors.forename: Matthias
authors.initials: M
authors.lastname: Schützwohl
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schuster
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Cervilla
authors.forename: Paulette
authors.initials: P
authors.lastname: Brangier
authors.forename: Jiri
authors.initials: J
authors.lastname: Raboch
authors.forename: Lucie
authors.initials: L
authors.lastname: Kališová
authors.forename: Georgi
authors.initials: G
authors.lastname: Onchev
authors.forename: Spiridon
authors.initials: S
authors.lastname: Alexiev
authors.forename: Roberto
authors.initials: R
authors.lastname: Mezzina
authors.forename: Pina
authors.initials: P
authors.lastname: Ridente
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
authors.forename: Ellen
authors.initials: E
authors.lastname: Visser
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kiejna
authors.forename: Tomasz
authors.initials: T
authors.lastname: Adamowski
authors.forename: Dimitri
authors.initials: D
authors.lastname: Ploumpidis
authors.forename: Fragiskos
authors.initials: F
authors.lastname: Gonidakis
authors.forename: José
authors.initials: J
authors.lastname: Caldas-de-Almeida
authors.forename: Graça
authors.initials: G
authors.lastname: Cardoso
authors.forename: Michael B
authors.initials: MB
authors.lastname: King
mesh_terms: D019985:Benchmarking; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D008603:Mental Health; D008605:Mental Health Services / Q000592:standards*; D059039:Standard of Care