title: Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis.
abstract: BACKGROUND
  The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients.
  
  
  METHODS
  QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level.
  
  
  RESULTS
  We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled.
  
  
  CONCLUSIONS
  This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.
authors: Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK. h.killaspy@ucl.ac.uk.
authors: Helen
authors: H
authors: Killaspy
authors: CEDOC and Mental Health Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. graca.cardoso@fcm.unl.pt.
authors: Graça
authors: G
authors: Cardoso
authors: Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK. swhite@sgul.ac.uk.
authors: Sarah
authors: S
authors: White
authors: Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK. cwright@sgula.c.uk.
authors: Christine
authors: C
authors: Wright
authors: CEDOC and Mental Health Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. caldasjm@fcm.unl.pt.
authors: José Miguel
authors: JM
authors: Caldas de Almeida
authors: Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK. pturton@sgul.ac.uk.
authors: Penny
authors: P
authors: Turton
authors: Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK. t.taylor@ucl.ac.uk.
authors: Tatiana L
authors: TL
authors: Taylor
authors: Department of Psychiatry and Psychotherapy, University Hospital, Technische Universitaet Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Matthias.Scheutzwohl@uniklinikum-dresden.de.
authors: Matthias
authors: M
authors: Schützwohl
authors: Department of Psychiatry and Psychotherapy, University Hospital, Technische Universitaet Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Mirjam.Schuster@uniklinikum-dresden.de.
authors: Mirjam
authors: M
authors: Schuster
authors: CIBERSAM, Department of Psychiatry, Universidad de Granada, Avenida de Madrid 11, 18012, Granada, Spain. jacb@ugr.es.
authors: Jorge A
authors: JA
authors: Cervilla
authors: CIBERSAM, Department of Psychiatry, Universidad de Granada, Avenida de Madrid 11, 18012, Granada, Spain. pbrangier@ugr.es.
authors: Paulette
authors: P
authors: Brangier
authors: Department of Psychiatry, lst Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague 2, Czech Republic. raboch@nbox.cesnet.cz.
authors: Jiri
authors: J
authors: Raboch
authors: Department of Psychiatry, lst Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague 2, Czech Republic. lucie.kalisova@yahoo.com.
authors: Lucie
authors: L
authors: Kalisova
authors: Department of Psychiatry, Medical University Sofia, St Georgi Sofiisky str. L, Sofia, 1431, Bulgaria. georgeonchev@hotmail.com.
authors: Georgi
authors: G
authors: Onchev
authors: Department of Psychiatry, Medical University Sofia, St Georgi Sofiisky str. L, Sofia, 1431, Bulgaria. salexiev@yahoo.com.
authors: Spiridon
authors: S
authors: Alexiev
authors: Dipartimento di Salute Mentale, Via Sai, 1-3, Trieste, 34127, Italy. roberto.mezzina@ass1.sanita.fvg.it.
authors: Roberto
authors: R
authors: Mezzina
authors: Dipartimento di Salute Mentale, Via Sai, 1-3, Trieste, 34127, Italy. pina.ridente@ass1.sanita.fvg.it.
authors: Pina
authors: P
authors: Ridente
authors: University Medical Centre, Hanzeplein1, Groningen, 9700 RB, Netherlands. Durk.Wiersma@med.umcg.nl.
authors: Durk
authors: D
authors: Wiersma
authors: University Medical Centre, Hanzeplein1, Groningen, 9700 RB, Netherlands. E.Visser@med.umcg.nl.
authors: Ellen
authors: E
authors: Visser
authors: Department of Psychiatry, Wroclaw Medical University, Pasteura 10, Wroclaw, 50-367, Poland. akiejna@psych.am.wroc.pl.
authors: Andrzej
authors: A
authors: Kiejna
authors: Department of Psychiatry, Wroclaw Medical University, Pasteura 10, Wroclaw, 50-367, Poland. adamowsk@psych.am.wroc.pl.
authors: Tomasz
authors: T
authors: Adamowski
authors: University Mental Health Research Institute, Soranou Tou Efessiou 2, Athens, 11527, Greece. diploump@med.uoa.gr.
authors: Dimitris
authors: D
authors: Ploumpidis
authors: University Mental Health Research Institute, Soranou Tou Efessiou 2, Athens, 11527, Greece. fragoni@yahoo.com.
authors: Fragiskos
authors: F
authors: Gonidakis
authors: Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK. michael.king@ucl.ac.uk.
authors: Michael
authors: M
authors: King
mesh_terms: D003430:Cross-Sectional Studies; D003688:Deinstitutionalization / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000523:psychology / Q000592:standards; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation; D008603:Mental Health / Q000592:standards; D008605:Mental Health Services / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care / Q000592:standards; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data