Evaluation of care quality for disabled older patients living at home and in institutions

Abstract

Aims and objectives: This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions.

Background: Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care.

Design: Retrospective study extracting patient data from Taiwan's National Health Insurance database.

Methods: We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed.

Results: The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death.

Conclusions: Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations.

Relevance to clinical practice: Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older patients.

Keywords: care quality; disabled; home care; institutional care; older.