Quality indicators for home"and community"based aged care : a critical literature review to inform policy directions

Objectives: Australia is lagging behind other countries in implementing quality indicators (QIs) in home- and community-based aged care. This research aimed to identify and appraise home care QI sets used internationally for older adults, to inform the future development and utilisation of QIs in the Australian context. Methods: A systematic search of eligible studies outlining the development and validation of home care QI sets for older adults was undertaken. QIs were categorised using the Donabedian model to identify potential gaps in coverage of key areas of care quality. Each QI was classified as potentially "derivable" or not from existing national routinely collected datasets. Methodological quality was determined using the Appraisal of Indicators through Research and Evaluation instrument. Results: Three sets of home care QIs developed and used internationally for older adults were identified. Two of the QI sets focused predominantly on clinical and functional aspects of care. Of 45 unique QIs, the majority were outcome measures (93%), with only three QIs measuring care processes (7%), and zero indicators measuring quality in terms of the structure of care (e.g., waiting time to access services). Nearly half of the individual indicators identified would require Australian home care providers to undertake additional data collection. There were significant methodological limitations in the development of QI sets, particularly in the scientific evidence domain. Conclusions: This review identified important gaps in existing QI sets, which should be considered by policymakers, researchers, and other stakeholders when developing and applying QIs in the Australian setting.