Quality and Outcomes of Person-centred Care Policy Research Unit (QORU), Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK.
Quality and Outcomes of Person-centred Care Policy Research Unit (QORU), Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK.
Soc Sci Med. 2019 Dec;243:112635. doi: 10.1016/j.socscimed.2019.112635. Epub 2019 Oct 23.
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.
护理质量具有多个维度，包括安全性、体验和效果。了解这些维度之间的关系对于政策和实践很重要，因为在试图最大化它们时，可能会同时存在协同作用和权衡取舍。在长期的家庭护理中，效果被理解为促进高质量生活（QoL）的护理。在这里，我们研究了长期家庭护理中护理体验与 QoL 之间的关系。我们使用分数响应回归模型分析了 2008/09 年进行的横断面调查的数据，以探索通过捕捉护理提供过程感知的项目来衡量的体验与通过 ASCOT 衡量的患者报告的 QoL 结果之间的关系，同时控制相关的个体特征。该分析包括了来自英格兰各地使用家庭护理服务的 14172 名 65 岁及以上的人。在控制个体特征的混杂效应后，发现总体过程质量增加 10%，平均与 ASCOT 增加 2.13%相关。护理的人际方面，例如员工的响应能力和关爱行为，与 ASCOT 的关系比与提供者组织护理相关的方面（例如守时和护理连续性）更强，前者增加 10%，平均与 ASCOT 增加 1.9%相关，后者增加 10%，平均与 ASCOT 增加 0.3%相关。对护理体验的看法，特别是与人际护理方面相关的看法，与 QoL 结果有重要关联。因此，人际护理方面的体验衡量标准可能是长期家庭护理服务常规监测 QoL 结果的有用指标。尽管存在关联，但这两个维度是不同的，对于政策制定者来说，评估护理体验和 QoL 结果都具有价值。
