Introduction

Hein van Hout

coordinator

Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care

http://www.ehma.org/

Mission (im)possible?

Projection of ageing and costs of long term care

European variation in care systems

• Population

• Governmental policy

• Governmental spending long term care

• Reimbursement

• Availability (in)formal care

• Accessibility and equity

Van Eenoo et al, 2015

‘Traditional’ benchmarking in health care

Often either:

→ Costs

→ Quality

Possible goals:

• Quality improvement

• Choice information for general public

• Accountability to government and care insurers

• Financial incentives

What’s new?

• Integrating quality of care & costs of care metrics

• Data derived from routine care assessments

• Relate country, organisation and staff characteristics to costs and quality of care

Method to learn from other organisations & regions

Aim

To identify best practices in community health care delivery for care-dependent elderly

HowDevelop and test a new method to benchmark thecosts & quality, and relate this to the organisation of community care

Structure and outline

PHASE 3:

DATA ANALYSIS

MANAGEMENT AND

COORDINATION

DISSEMINATION

PHASE 1:

PREPARATION

WP 1

Project management and coordination

WP 3 Recruitment and assessment

PHASE 2: METHOD DEVELOPMENT

AND ASSESSMENTS

WP 5 Benchmarking costs of care

WP 8 Dissemination of IBenC results

WP 6 Identify care models for community care in health systems in six countries

WP 7 A benchmarking method to identify cost-effective practices

WP 4 Data management

WP 2

Benchmarking quality of care

1

Cost-quality of care ratio

Quality of care

Costs of careStructure

Policy

Processes

Finances

Job characte-ristics

Personal characteristics

Demographics

Clientoutcomes

MACRO

MESO

MICRO

DesignSocial context

Organizations

Staff

interRAI-Home Care (HC)

31,2%68,8%

• Standardized comprehensive geriatric assessment instrument (300+ items)

• Used in Routine care in many countries

Decision support for Multiple purposes:

→ Scales for monitoring clients

→ Risk triggers for individualized care planning

→ Quality indicators (23 HCQIs, 2 summaries)

→ Staff resource planning (RUG-III/HC)

→ Resource use -> Care costs

Hirdes et al, 2008

nc = 499 no = 2

nc = 491 no = 3

nc = 420 no = 1

nc = 456 no = 3

nc = 493 no = 11

2884

38

1067

nc = 525 no = 18

IBenC study sample

Demographics IBenC sample

Ownership19% public14% profit68% not for profit

Demographics IBenC sample

Overall mean age 82 (±7) years

18% cognitive impaired (CPS>2)21% depressive symptoms (DRS>2)41% extensive ADL support25% Pain (scale≥ 2)

33%67%

Lives alone 58%Married 31%

informal carer present 85%child 51%

spouse 21%other 13%

311

312

313

321

331

332

333

334

335

341

342

0,0

1,0

2,0

3,0

4,0

5,0

6,0

0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0

Me

an A

DL

Hie

rarc

hy

Scal

e s

core

Mean Cognitive Performance Scale score

Impairment∆ Italy∆ The Netherlands∆ Belgium∆ Iceland∆ Finland

∆ Germany

Variation across organisations & countries

313

321

331

332

333

335

341

342

401

501

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0%

# h

ou

rs p

rofe

ssio

nal

car

e

QI score

Performance Pain Italy

The Netherlands

Belgium

Iceland

Finland

Germany

Variation in quality outcomes: presence of pain

Benchmarking quality against costs

€High

low

quality of care outcomes

Low good

Mission (im)possible!

Take home message

• Benchmarking Quality & cost method avaiable

• Powerful method for reciprocal benchlearning

Benchmarking outcome(s)

Thank you

Questions?