Targeting and quality of nursing home care. A five-nation study

The objective of this study was to demonstrate that appropriate targeting a nd quality monitoring of institutional care of the elderly is possible usin g person-based information on residents of nursing homes. This cross-sectio nal study used Minimum Data Set (MDS) assessments of nursing home residents in 6 US states, Copenhagen, Reykjavik, and selected locations in Italy and Japan. The outcome measures were life expectancy at age 65, population ove r 65, percentage over 65's in nursing homes, and clinical characteristics o f nursing home residents from a multinational database of RAI/MDS assessmen ts. We found that Japan has the highest life expectancy, and the second low est expenditure on health care. The United States has the highest expenditu re on health care and intermediate life expectancy. Italy has the highest p roportion of population over 65 and the lowest proportion of over 65's in n ursing homes. Iceland, a relatively young country, has the highest proporti on of over 65's in nursing homes. Residents in Italy and the United States had the most severe physical, cognitive and clinical characteristics, those in Iceland the least. There was wide variation in markers of quality of ca re, with no country either uniformly good or bad across multiple measures. In conclusion, headline statistics comparing nations' percentage of Gross D omestic Product (GDP) spent on health care, age structure of the population , percentage of over 65's in nursing homes and clinical characteristics bea r no consistent relationship. Local policy and practice also affect quality of care. Standardized assessment enables comparisons at local, national an d international levels making possible further research on targeting and th e appropriate use of institutional care, thus permitting a range of efficie ncy measures to be developed to inform policy. (C) 1999, Editrice Kurtis.