IBenC : Identifying Best practices for care dependent elderly by Benchmarking Costs and outcomes of community care 2013-2016 IAGG 2013, Seoul, South Korea H. van der Roest; G. Onder; A. Declercq; V. Garms-Homolova; P. Jonsson; H. Finne-Soveri; J. Smit; J. Bremner; H. Van Hout VU University medical center Amsterdam Dept General Practice & Elderly Care Medicine

Background Quality of care in EU challenged numbers of frail and disabled elderly  portion 80+  younger working population  Difficulties in ADL and co-morbidity 40% of health care spending persons ≥ 65 years cost drivers: admission to hospitals and long term care facilities Good community care may be key to reduce costs

Background How can we identify good quality care? Quality of care, costs of care and health outcomes are interrelated (Donabedian et al, 1982) Highest quality of care, gains the maximum expected improvements in health status, including physical, physiological and psychological dimensions of health. And care executed with optimal efficiency. , thus resources are used optimally, and waste of resources like underutilization of facilities and inadequate task performance or coordination should be avoided

Issues Benchmarking community care quality of care is not uni dimensional lack of standardisation of quality of care assessments lack of standardisation of cost diversity service models and case mix

Diversity service models and case mix Onder et al, 2012

Service models Describe country / regional context Identify generic en specific elements

Aim of IBenC Aim: to identify best practices of home care delivery for care dependent community dwelling elderly How: Benchmark cost-effectiveness of home care: - summary score quality of care - integrated measure of care costs with quality of care 2) Characterise best practices: staff characteristics, management structures, care processes, and reimbursement

Consortium WA

Structure and outline

Main instruments Health outcomes and costs of care InterRAI Home Care (HC) patient outcomes quality indicators Costs of care validation RUD Lite (Wimo et al, 2012) EQ-5D (EuroQol group, 1990)

InterRAI HC Advantages Validated methodology Routine care assessements Various scales and CAPs 22 quality indicators Benchmarking between facilities, regions, countries

Assessments INTRO – METHOD - PLAN

Community care organisations Diversity in Structure Regional policy Social context Staff characteristics

Costs of care – societal perspective Bottum up approach Formal care: hospital stay drug use home nurse care treatment Informal care: hours of help relatives + TOTAL ……

Cost-quality of care ratio € outcome

Expectations Provide more insight in European community care by: Developing a novel method to benchmark costs and quality of care Improving the comparability of cost of care data Provide relevant information to European, national and regional health care policy makers for decision making Advance economic efficiency of services across Europe EMGO Instituut - Care and Prevention

www.ibenc.eu hg.vanderroest@vumc.nl EMGO Instituut - Care and Prevention