Benchmarking european community care delivery on costs and quality of care, a novel approach

To deliver adequate care in the future to the rapidly ageing population and avoid excessive costs, reform of healthcare systems is necessary. Evidence-based restructuring of systems should build on reliable benchmarks of quality and costs of care, which are lacking. A novel benchmark method on organizational efficiency in community care was developed with the IBenC project.Longitudinal data collection was performed among 2884 community care clients (six countries, 38 organizations) by means of the comprehensive geriatric assessment instrument interRAI-HC. Baseline and six month follow-up assessments were used. The 11-point Independence Quality scale (IQS) and Clinical Balance Quality scale (CBQS) expressed quality, respectively reflecting quality of care aimed at functional independence and engagement, and at functional im-provement. Higher scores indicate better quality. Six month cost of care were estimated by valuing resource utilization with Dutch standard costs. Case-mix adjustments were applied.Organizational quality varied between poor to good: IQS scores varied between 2 and 7, CBQS between 4 and 8. Mean adjusted costs were 21.004 (range 14,300-24,209). Quality and cost outcomes were integrated in the IQS-index and CBQS-index. Index values of 1 indicate average quality against average costs, higher values reflect better organizational efficiency. IQs-index ranged between 0.49 to 1.74 and CBQS-index between 1.00 and 1.66. The indexes had high face-validity compared to the plotted costs and quality and discriminated organizations based on their efficiency. The indexes permit for a novel benchmark approach, opening up possibilities for unexplored Areas of research and knowledge in organizational performance and restructuring care systems.

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