Health-Related Quality of Life, Outcome and Patient Experience in Care Homes: A Study in Three Countries.

Tim Benson* Tim Benson*, Routine Health Outcomes Ltd, Newbury, United Kingdom
Clive Bowman, Routine Health Outcomes Ltd, Cardiff, United Kingdom

Track: Research
Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues
Presentation Type: Poster presentation
Submission Type: Single Presentation

Last modified: 2013-09-25

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Care homes increasingly care for people with substantial clinical needs, not only housing needs. Consequently, care quality is ever more important for patients, relatives, clinicians, managers, commissioners and regulators. Quality and satisfaction are hard to measure routinely especially in low cost environments and geographically isolated settings.
We set out to establish the feasibility and sensitivity of measuring health-related quality of life (HRQoL) and care experience for residents in 360 care homes in UK, Australia and New Zealand.

For health status (HRQoL) we used howRU, which has 4 generic questions on discomfort, distress, disability and dependence; for experience we used howRwe, with 4 questions on delay, communication, care and expectation, and the Net Promoter Score.
The project was designed and implemented centrally. Staff were notified in advance. OMR (optically mark readable) forms were sent to each home; responses were collected regionally and scanned centrally. The forms for each resident had three parts: (1) staff recorded demographic and clinical details and rated resident’s HRQoL, (2) residents assessed their own HRQoL and experience with or without help, (3) a visitor assessed experience.
We reported for the whole population, by region and by care home, and assessed agreement between staff, residents and visitors. We used summary indices for populations on a scale from 0 to 100.
The results were disseminated via tiered briefings, international, national, regional and to individual homes. Each region was provided with their core metrics by care home and raw data for further analysis.

Staff provided data on 19,202 residents (67% female, 33% male); 10,327 residents completed self-competion forms and 6,966 visitors reported their perceptions of resident experience.
We found that care home residents differ substantially from patients with long term-conditions living in the community. We found that HRQoL depends on case mix but in care homes it is insensitive to age; pain and discomfort are not strongly correlated with incapacity.

Residents with better HRQoL reported better experience. There are several possible explanations (1) It may be easier to provide better experience to relatively well residents, or (2) residents who feel well are more positive or (3) better quality care makes people feel better or (4) a combination of these. This is an important finding that may indicate a need to adjust experience scores for HRQoL.

Staff and residents did not agree on severe discomfort and distress, but agreed well on all other aspects of health status (65% exact agreement); this demonstrates the importance of asking residents.

Visitors scored higher than residents on resident experience although correlation between them was good. Frail elderly are the most critical residents. Residents were most critical about delays and communication.

The range of scores across care homes is wide, demonstrating that care homes are not homogeneous. Outliers were identified easily for further investigation. There are distinct profiles of resident groups.

This was a large project, which provided a snap-shot at a particular point of time. Tracking the HRQoL and experience of residents in each care home over time, perhaps weekly, offers benefits as an aide to individual care and care management within a home; aggregated data provides a clear line of site from board room to bedside.

We have demonstrated the practicality of measuring health status and experience at scale in at scale in care homes. These metrics (howRU and howRwe) are simple to use, yet provide results that clearly discriminate between different homes, groups of residents and their experience. We have further developed the tools and capability and now offer real-time quality monitoring on tablets for use in care homes.

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