TRANZO, Scientific Centre for care and welfare, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands.
BMC Health Serv Res. 2012 Jan 31;12:26. doi: 10.1186/1472-6963-12-26.
Every two years, long-term care organizations for the elderly are obliged to evaluate and publish the experiences of residents, representatives of psychogeriatric patients, and/or assisted-living clients with regard to quality of care. Our hypotheses are that publication of this quality information leads to improved performance, and that organizations with substandard performance will improve more than those whose performance is relatively good.
The analyses included organizational units that measured experiences twice between 2007 (t(0)) and 2009 (t(1)). Experiences with quality of care were measured with Consumer Quality Index (CQI) questionnaires. Besides descriptive analyses (i.e. mean, 5(th) and 95(th) percentile, and 90% central range) of the 19 CQI indicators and change scores of these indicators were calculated. Differences across five performance groups (ranging from 'worst' to 'best') were tested using an ANOVA test and effect sizes were measured with omega squared (ω(2)).
At t0 experiences of residents, representatives, and assisted-living clients were positive on all indicators. Nevertheless, most CQI indicators had improved scores (up to 0.37 change score) at t(1). Only three indicators showed a minor decline (up to -0.08 change score). Change scores varied between indicators and questionnaires, e.g. they were more profound for the face-to-face interview questionnaire for residents in nursing homes than for the other two mail questionnaires (0.15 vs. 0.05 and 0.04, respectively), possibly due to more variation between nursing homes on the first measurement, perhaps indicating more potential for improvement. A negative relationship was found between prior performance and change, particularly with respect to the experiences of residents (ω(2) = 0.16) and assisted-living clients (ω(2) = 0.15). However, the relation between prior performance and improvement could also be demonstrated with respect to the experiences reported by representatives of psychogeriatric patients and by assisted-living clients. For representatives of psychogeriatric patients, the performance groups 1 and 2 ([much] below average) improved significantly more than the other three groups (ω(2) = 0.05).
Both hypotheses were confirmed: almost all indicator scores improved over time and long-term care organizations for the elderly with substandard performance improved more than those with a performance which was already relatively good.
每两年，老年人长期护理机构都有义务评估并公布居民、心理老年患者代表和/或辅助生活客户对护理质量的体验。我们的假设是，发布这些质量信息会导致绩效提高，而绩效较差的组织的改善程度将超过绩效相对较好的组织。
分析包括在 2007 年（t(0)）和 2009 年（t(1)）之间两次测量体验的组织单位。护理质量体验使用消费者质量指数（CQI）问卷进行测量。除了对 19 个 CQI 指标的描述性分析（即平均值、第 5 和第 95 百分位数和 90%中心范围）外，还计算了这些指标的变化分数。使用方差分析检验五个绩效组（从“最差”到“最好”）之间的差异，并使用 ω 平方（ω(2)）测量效应大小。
在 t0 时，居民、代表和辅助生活客户的体验在所有指标上均为积极。尽管如此，大多数 CQI 指标在 t(1)时的得分有所提高（最高可达 0.37 变化分数）。只有三个指标显示出轻微下降（最高可达-0.08 变化分数）。变化分数在指标和问卷之间有所不同，例如，对于养老院的居民面对面访谈问卷来说，它们更为深刻（0.15 与其他两个邮件问卷相比分别为 0.05 和 0.04），这可能是由于第一次测量时养老院之间的差异更大，可能表明有更大的改进潜力。发现先前绩效与变化之间存在负相关关系，尤其是居民（ω(2) = 0.16）和辅助生活客户（ω(2) = 0.15）的体验。然而，也可以在心理老年患者代表和辅助生活客户的报告体验方面证明先前绩效与改善之间的关系。对于心理老年患者代表，绩效组 1 和 2（远低于平均水平）的改善明显超过其他三组（ω(2) = 0.05）。
两个假设都得到了证实：几乎所有指标得分都随着时间的推移而提高，绩效较差的老年人长期护理机构的改善程度超过了绩效已经相对较好的机构。
