title: Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).
abstract: BACKGROUND
  Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales.
  
  
  METHODS
  Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology.
  
  
  RESULTS
  A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark.
  
  
  CONCLUSIONS
  The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. andrea.foebel@ki.se.|Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy. andrea.foebel@ki.se.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Foebel
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. hpj.vanhout@vumc.nl.
authors.forename: Hein P
authors.initials: HP
authors.lastname: van Hout
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. hg.vanderroest@vumc.nl.
authors.forename: Henriëtte G
authors.initials: HG
authors.lastname: van der Roest
authors.affiliation: Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic. eva.topinkova@vfn.cz.
authors.forename: Eva
authors.initials: E
authors.lastname: Topinkova
authors.affiliation: HTW Berlin, University of Applied Sciences in Technology and Economics, Berlin, Germany. garmsho@htw-berlin.de.
authors.forename: Vjenka
authors.initials: V
authors.lastname: Garms-Homolova
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. d.frijters@vumc.nl.
authors.forename: Dinnus
authors.initials: D
authors.lastname: Frijters
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland. harriet.finne-soveri@thl.fi.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: Department of Geriatrics, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. palmivj@landspitali.is.
authors.forename: Pálmi V
authors.initials: PV
authors.lastname: Jónsson
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. hirdes@uwaterloo.ca.
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy. roberto.bernabei@rm.unicatt.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy. graziano.onder@rm.unicatt.it.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology; D015331:Cohort Studies; D018153:Czech Republic; D003718:Denmark; D005006:Ethnicity; D005260:Female; D005387:Finland; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D005858:Germany; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D017146:Models, Organizational; D009426:Netherlands; D019984:Quality Indicators, Health Care / Q000592:standards; D011788:Quality of Life