What is the relationship between the quality of care experience and quality of life outcomes? Some evidence from long-term home care in England.

Quality of care has multiple dimensions, including safety, experience and effectiveness. Understanding the relationship between these dimensions is important for policy and practice, since there may be both synergies and trade-offs that occur when attempting to maximise them. For long-term care effectiveness is understood as care that promotes a good quality of life (QoL). Here we investigate the relationship between care experience and QoL in long-term home care. Data from a cross-sectional survey conducted in 2008/09 were analysed using fractional response regression models to explore the relationship between experience, measured through items capturing perceptions of the care delivery process, and patient-reported QoL-outcomes, measured using ASCOT, controlling for relevant individual characteristics. The analysis included 14,172 people aged 65 and over using home care services from across England. After controlling for the confounding effect of individual characteristics, a ten percentage point increase in overall process quality is found to be associated on average with a 2.13 percentage point increase in ASCOT. Interpersonal aspects of care, such as the responsiveness and caring behaviour of staff, have a stronger relationship with ASCOT than those related to the organisation of care by the provider, such as timekeeping and continuity of care, with a ten percentage point increase in the former associated on average with a 1.9 percentage point increase in ASCOT and a ten percentage point increase in the latter associated on average with a 0.3 percentage point increase in ASCOT. Perceptions of care experience, particularly those related to the interpersonal care aspects, have an important association with QoL-outcomes. Measures of the experience of interpersonal aspects of care may therefore be useful indicators of QoL-outcomes for the routine monitoring of long-term home care services. Although associated, the two dimensions are distinctive and for policymakers there is value in assessing both care experience and QoL-outcomes.