Performance indicators in long-term care for older people in 38 countries: a scoping review

BACKGROUND: A large number of performance indicators in long-term care have been developed and tested. However, the use of such indicators for regular monitoring of long-term care at regional and national level presents a number of challenges related to coordination of stakeholders, regulation and data collection capabilities. Our aim was to review the performance indicators in long-term care that are currently in use for regular monitoring by 38 OECD member states. METHODS: We used a scoping review approach that included a systematic search of scientific publications, review of multi-country reports and an internet search of relevant websites of the countries included. The scoping review protocol was registered before starting paper selection and web searches. RESULTS: We retrieved 12.776 papers, of which 10 were kept after selection for data extraction. Preliminary results of the review of reports and internet resources led to the retrieval of 399 performance indicators in long-term care from 24 OECD member states, while no indicators could be found for 14 member states. Performance indicators most often relate to falls, pressure ulcers, unplanned weight loss and use of restraints, which are collected by 7 or more of the 24 countries. The definitions of the indicators differ considerably between countries, as well as the definitions of long-term care and hence the settings in which these indicators are used. CONCLUSIONS: Consideration of indicators often used in several countries may be of interest to decision-makers establishing or updating indicator sets in this area. There is considerable heterogeneity in the nature, definitions and settings of long-term care performance indicators used by OECD member states. These differences are a significant challenge to establish international comparability of the indicators reported. KEY MESSAGES: • The indicators most frequently used for regular monitoring of long-term care performance are related to falls, pressure ulcer, unplanned weight loss and use of restraints. • There is considerable heterogeneity in the nature, definitions and settings of long-term care performance indicators used in different countries, which make comparisons of results challenging.