A set of indicators for monitoring the care process of disable elderly - the PIC Project

Background Access and continuity of care for elderly disable people is becoming a priority for disabled elderly care in Western countries. This study aimed at defining and using a set of indicators for evaluating care delivered to disabled elderly accordingly a process approach in local areas of three Italian regions – Lombardy, Veneto, Tuscany. Methods Access, multidimensional evaluation/care planning, providers coordination/case management, and monitoring composed the care process phases. Secondary data from home care and residential care national information systems were used. All records relative to residents in Milano Local Health Unit (LHU), Vicenza and Alto vicentino LHUs, Societa` della Salute (SdS) of Firenze and Pisa, aged ≥65years, assisted at least one day between July, 1 2010 and June, 30 2011 were extracted from national databases. These records were linked with hospital discharges and emergency room access databases. The outcome measures were ratios, arithmetic means, incidence rates, Odds Ratio (CI 95%) adjusted for the main confounders. Results Of 7.237 disable elderly 65% were women and 47% ≥85 years old. Concerning access to the system and services delivered in residential or home care, the coverage rates ranged from 82% in Milano LHU to 15% in Tuscany SdS. With regard to care planning, the mean waiting time between multidimensional evaluation and first access at elderly’s home was 2 days in Milano LHU, 90 days in Tuscany Sds, 31 days in Veneto LHUs. The mean waiting time before being institutionalized was around 54 days in Tuscany and 45 days in Veneto LHUs. Aggregate Bed Day Rate for home care elderly ranged from 13.5/person-years in Milano LHU to 3.8/person-years in Tuscany Sds; while for institutionalized elderly it ranged from 2.5/person-years in Milano LHU to 0.8/person-years in Veneto LHUs. If social network is absent the odd of being institutionalized vs being assisted at home increased (OR 4.86, CI 2.84-8.32 in Tuscany Sds, OR 45.10, CI 25.79-78.85 in Veneto LHU). Conclusions This study developed an innovative methodology based on administrative data to support the public governance of elderly disable healthcare services. Differences found between regions might depend on organizational or cultural reasons and need further analyses. Key message This study developed an innovative methodology using administrative data to support the public governance of elderly disable healthcare services.