Health Service Quality: An introduction to quality methods for health services

Introduction: Providing integrated health and social care for older persons - a European overview, Kai Leichsenring Integrated health and social care for older persons: theoretical and conceptual issues, Andy M. Alaszewski, Jenny Billings and Kirstie Coxon. National Reports: Providing integrated health and social care for older persons in Austria, Margit Grilz-Wolf, Charlotte Strumpel, Kai Leichsenring and Kathrin Komp Providing integrated health and social care for older persons in Denmark, Ellinor Colmorten, Thomas Clausen and Steen Bengtsson Providing integrated health and social care for older persons in Finland, Paula Salonen and Riitta Haverinen Providing integrated health and social care for older persons in France - an old idea with a great future, Michel Frossard, Nathalie Genin, Marie-Jo Guisset and Alain Villez Providing integrated health and social care for older persons in Germany, Gunter Roth and Monika Reichert Providing integrated health and social care for older persons in Greece, Aris Sissouras, Maria Ketsetzopoulou, Nikos Bouzas, Evi Fagadaki, Olga Papaliou and Aliki Fakoura Providing integrated health and social care for older persons in Italy, Giorgia Nesti, Stefano Campostrini, Stefano Garbin Paolo Piva Patrizia Di Santo and Filomena Tunzi Providing integrated health and social care for older persons in the Netherlands, Carine Ex, Klaas Gorter and Uschi Janssen Providing integrated health and social care for older persons in the United Kingdom, Kirstie Coxon, Jenny Billings and Andy M. Alaszewski Index.

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Providing Integrated Health and Social Services for Older Persons: A European Overview of Issues at Stake

Scand J Caring Sci; 2010; 24; 164–174 Quality of care and service trajectories for people with intellectual disabilities: defining the aspects of quality from the client’s perspective



Background:  Care and service trajectories for people with intellectual disabilities (i.e. people with mental retardations) are routes within the healthcare delivery system that consist of all the steps that people with intellectual disabilities and their families have to take in order to realise the needed care and services.



Aim:  This article aims to identify the quality aspects of trajectories that are considered important by people with intellectual disabilities and their parents/relatives. In addition, it examines how these aspects are related to quality determinants mentioned in the literature on integrated care and to authoritative models for quality assessment of care and service delivery.



Methods:  Quality aspects were collected during eight focus group discussions with people with intellectual disabilities or their parents/relatives. In addition, quality determinants of integrated care and authoritative models for quality assessment were selected by means of a thorough review of the literature. Finally, the quality aspects identified using focus groups were compared to the determinants and models found in the literature.



Results:  The quality aspects presented by people with intellectual disabilities referred particularly to the immediate situation in receiving care and services, such as ‘keeping appointments’ and ‘time and attention’, whereas parents/relatives also referred to broader ‘organisational issues’, such as ‘access to support’ and ‘problems with placement’. The quality aspects, however, are minimally related to the quality determinants of integrated care, probably because clients and their parents/relatives find it difficult to have an overview of the coherence between the various actions that have to be performed, when going through the trajectories. In contrast, the quality aspects seem to fit into the domains of the authoritative models for quality assessment, probably because of the minimal focus of the models on long-term aspects in care and service delivery.

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Quality of care and service trajectories for people with intellectual disabilities: defining the aspects of quality from the client’s perspective

Care and service trajectories are identifiable routes through service systems that consist of all steps that people with intellectual disabilities (ID) and their families have to take to realize the care and services they need. Trajectories are especially prominent during the transitions from children's services to adult services. Within a service system in Noord-Brabant (in the Netherlands), the authors examined the course of such trajectories and their main bottlenecks and sought to identify their quality determinants. The first research question was addressed by an exercise in document analysis and the holding of semistructured interviews with key informants within the healthcare sector specialized for serving people with ID. A second research question was addressed by means of a literature review on integrated care. The authors observe that trajectories generally follow a “model route” consisting of five phases but may vary according to age category, degree of disability, and life domain. With respect to “bottlenecks,” the authors noted that a lack of suitable supply and long waiting lists are good examples. They found that the literature on integrated care revealed that continuity, accessibility, availability, and flexibility of care and services, together with the seamlessness of transitions, are all important quality determinants for people with ID when judging their service trajectories. Bottlenecks and quality determinants of trajectories are strongly interrelated. The authors concluded that the literature and the key informants agree as to which factors are most important in realizing high-quality trajectories for individual clients. They recommend asking which criteria people with ID and their families value most when judging the quality of trajectories.

Care and Service Trajectories for People With Intellectual Disabilities: Defining Its Course and Quality Determinants From the Client's Perspective

Quality in Health Care: Theory, Application, and Evolution

Purpose: to determine if and how the outcome quality from a client perspective is related to process characteristics and structure of Regional Individual Needs Assessment Agencies (RIOs) regulating access to long-term care services in the Netherlands. Theory: because of decentralised responsibilities, ultimo 1999 85 RIOs were set up. RIOs differ in their structural and process characteristics. This could lead to differences in client quality. Insight into factors relating to client quality (e.g. client satisfaction) can improve the needs assessment process. Methods: Eighteen RIOs participated in this study. These RIOs each selected 120 clients, filled in forms about their needs assessment procedures and sent them a questionnaire assessing judgements, experiences and satisfaction with the RIO. Results: We received 1916 RIO-forms and 1062 client questionnaires. Eighty-two percent of the clients were satisfied with the RIO, the percentages not satisfied clients varied from 10 to 29% among items and working procedures. Satisfaction is mostly related to what is actually done for the client. Information aspects and providing choices are important determinants of client quality with the RIO. Conclusion: In improving quality seen from a client perspective, one should focus on what is actually done for the client, rather than looking at the RIOs structure.

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S. Jedeloo

Papers

Quality of regional individual needs assessment agencies regulating access to long term-care services: a client perspective