1. Titel voorbeeld titel The relationship between care practice organization and quality of care in long term care facilities in Europe Background Care practice in long term care facilities (LTCFs) differs across Europe. The European Observatory on Health Systems promotes evidence based health policy through comprehensive analysis of the dynam- ics of health care systems. Until now, no rigorous research has been performed to compare differences between European care facilities and quality of care. This study is part of the Services and Health for the Elderly in Long TERm care (SHELTER) project of the 7th Framework Programme (FP7). The aim of the SHELTER project is to validate the Resident Assess- ment Instrument for long term care (interRAI-LTCF) as a methodology to assess long term care in Europe. The SHELTER project leads to the creation of the first large database with LTCF patient outcomes in Europe. In this study we address cross-cultural differences in quality of care related to the organization of LTCF care practice. Methods The SHELTER study has a cross-sectional longitudinal design. Data were collected at baseline and subsequently six and twelve months later, using the interRAI-LTCF. At baseline 4,156 LTCF residents, living in 59 LTCFs in the Czech Republic, Germany, the United Kingdom, Finland, France, Israel, Italy, and the Netherlands were included. The interRAI-LTCF produces Quality Indicators (QIs) relevant for long term care. Additional data on LTCF organization, staffing, and care processes were collected using a standard- ized form. Preliminary results 54.1% of the LTCFs were run by public ownership, while 45.9% were private facilities. In Finland, France and the Netherlands all included facilities were public, while in the UK all participating facilities were privately owned. On average Finland (414,  373) and Israel (234,  213) had the most beds, while Italy had the fewest beds (70,  31) per LTCF. Examples of the relationship between QIs and LTCF structure The higher the ratio of licensed nurses per LTCF bed, the lower the prevalence of depression (r = -0.37, p = 0.01). The higher the ratio of nurse aides per LTCF bed, the lower the use of antipsychotics (r = -0.45, p < 0.01). Examples of the relationship between QIs and LTCF process Standardized assessments of depression were significantly associated with higher prevalence rates of depression (F = 4.06; p = 0.05). A multidisciplinary team approach made no difference on the prevalence of behavioural problems, little or no activity, inadequate pain management, or depression (p > 0.05). Discussion Quality of care is multidimensional. LTCFs that perform well on a clinical domain, do not necessary perform well on all domains. Standardized assessments do not always lead to wanted health care outcomes. Performing standardized assessments enables detection of unwanted patient health outcomes in long term care, stimulating specific improvement projects. Preliminary results of the SHELTER project H.G. van der Roest, D.H.M. Frijters VU University medical center, Department of Nursing Home Medicine, EMGO + Institute, Amsterdam Table 1: Prevalence (%) of unwanted health care outcomes, i.e. QIs, in Europe. The lower the score, the better the performance. Contact: hg.vanderroest@vumc.nl