Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.
BACKGROUND
The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care.


METHODS
At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables.


RESULTS
1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy.


CONCLUSIONS
Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.
Mental Health Sciences Unit, University College London, London, United Kingdom. h.killaspy@ucl.ac.uk
Helen
H
Killaspy
Sarah
S
White
Christine
C
Wright
Tatiana L
TL
Taylor
Penny
P
Turton
Thomas
T
Kallert
Mirjam
M
Schuster
Jorge A
JA
Cervilla
Paulette
P
Brangier
Jiri
J
Raboch
Lucie
L
Kalisova
Georgi
G
Onchev
Spiridon
S
Alexiev
Roberto
R
Mezzina
Pina
P
Ridente
Durk
D
Wiersma
Ellen
E
Visser
Andrzej
A
Kiejna
Patryk
P
Piotrowski
Dimitris
D
Ploumpidis
Fragiskos
F
Gonidakis
José Miguel
JM
Caldas-de-Almeida
Graça
G
Cardoso
Michael
M
King
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe / Q000453:epidemiology; D005260:Female; D006268:Health Facilities / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data*; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D055815:Young Adult