Article type
Abstract
Background
Many countries have reformed their healthcare system focusing on aging-in-place, as it is perceived to be cost-saving and a possible solution to cope with the increasing prevalence of older adults. There is a critical need to evaluate the effect of aging-in-place policies to assess how arrangements can be optimized for both quality and cost. A universal performance assessment framework could help conceptualize and standardize measurements, quantify changes, and set benchmarks. This study provides the first step toward building this framework.
Objectives
The aim of this study was to conduct a scoping review to identify what performance indicators are used to evaluate aging-in-place reforms. An evidence map was created to provide a comprehensive overview of the identified performance indicators.
Methods
Studies that evaluated aging-in-place reform policies on a (sub)national scale were eligible for inclusion. The search strategy was performed in Ovid MEDLINE, Ovid Embase, and EBSCOhost Academic Search Premier. The performance indicators were classified into the Donabedian framework as structure, process, or outcome indicators, by performance domain and by care level. An evidence map with a Sankey diagram was created to visualize the connection between the classification categories.
Results
A total of 58 articles were included in this scoping review. All research originated from high- and middle-income countries. Most studies were descriptive, describing general trends of performance indicators before and after ageing-in-place reform implementation; 24% of the studies were analytic, ie, investigating associations. Twenty-seven articles discussed structure indicators, comprising 71 performance indicators related to the performance domains expenditures, care availability, and workforce; 34 articles included process indicators, comprising 80 indicators in the domains care utilization, service quality, and satisfaction; and 21 articles reported on outcome indicators, comprising 34 indicators about the domains health status and informal caregiving. Most indicators were measured at the home and community-based care level.
Conclusions
Most performance indicators for evaluation of aging-in-place reform focused on health care expenditures and utilization, whereas outcome indicators related to the health and well-being of older adults and their informal caregivers were less often reported. A holistic framework to assess effects of aging-in-place reforms with actionable performance indicators is recommended.
Many countries have reformed their healthcare system focusing on aging-in-place, as it is perceived to be cost-saving and a possible solution to cope with the increasing prevalence of older adults. There is a critical need to evaluate the effect of aging-in-place policies to assess how arrangements can be optimized for both quality and cost. A universal performance assessment framework could help conceptualize and standardize measurements, quantify changes, and set benchmarks. This study provides the first step toward building this framework.
Objectives
The aim of this study was to conduct a scoping review to identify what performance indicators are used to evaluate aging-in-place reforms. An evidence map was created to provide a comprehensive overview of the identified performance indicators.
Methods
Studies that evaluated aging-in-place reform policies on a (sub)national scale were eligible for inclusion. The search strategy was performed in Ovid MEDLINE, Ovid Embase, and EBSCOhost Academic Search Premier. The performance indicators were classified into the Donabedian framework as structure, process, or outcome indicators, by performance domain and by care level. An evidence map with a Sankey diagram was created to visualize the connection between the classification categories.
Results
A total of 58 articles were included in this scoping review. All research originated from high- and middle-income countries. Most studies were descriptive, describing general trends of performance indicators before and after ageing-in-place reform implementation; 24% of the studies were analytic, ie, investigating associations. Twenty-seven articles discussed structure indicators, comprising 71 performance indicators related to the performance domains expenditures, care availability, and workforce; 34 articles included process indicators, comprising 80 indicators in the domains care utilization, service quality, and satisfaction; and 21 articles reported on outcome indicators, comprising 34 indicators about the domains health status and informal caregiving. Most indicators were measured at the home and community-based care level.
Conclusions
Most performance indicators for evaluation of aging-in-place reform focused on health care expenditures and utilization, whereas outcome indicators related to the health and well-being of older adults and their informal caregivers were less often reported. A holistic framework to assess effects of aging-in-place reforms with actionable performance indicators is recommended.