Monitoring the care process of disable elderly, reports for doing public governance: do they work?

Background There has been an increasing interest and necessity to measure Long term care - LTC services for dependent elderly. The LUNA study conducted by the National Agency for regional healthcare services aimed to contribute to the development and implementation of a governance tool to monitor and improve LTC services. Methods A set of indicators for evaluating care delivered to disabled elderly in local areas of five Italian regions – Lombardy, Veneto, Tuscany, Apulia, Emilia Romagna was defined and a report was developed as governance tool. All records relative to residents in Brescia Local Health Unit (LHU), Vicenza LHU, Tuscany, Taranto LHU, Bologna LHU aged 65years, assisted at least one day between Jan, 1 2012 and June, 30 2013 were extracted from national home and residential care 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. Independent audit and coordinated focus groups were performed across the LHU involved to test the utility of the report as governance tool. Results 33 indicators on access, multidimensional evaluation, tempestivity, continuity, efficacy were calculated. An example of appropriateness regards the Emergency Access rate with white or green code of elderly in home care. The rates were 28% person-years at Brescia, 80% person-years at Empoli, 38% at Bologna, 37% at Vicenza and 19% person-years at Taranto. 8 focus groups were performed involving 87 professionals and stakeholders of LTC services. Qualitative concerns reveal that despite the high validity of the set of indicators developed, less technicality and a deeper bottom up approach in the set of indicators design and selection would have been recommended from the health care professionals and governors involved in the implementation of the report as governance tool. The report was appreciated as tool for integration. Conclusions Regional differences either in process of care either in the usefulness of the tool were found. Further analyses are needed to improve this innovative quality instrument in order to be easily implemented to do public governance of LTC services and focus also on equity aspects. Key message reports to do public governance of LTC service are needed