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The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project)

Dinnus HM Frijters1*, Henriëtte G van der Roest1, Iain GI Carpenter2, Harriet Finne-Soveri3, Jean-Claude Henrard4, Angela Chetrit5, Jacob Gindin5 and Roberto Bernabei6

Author Affiliations

1 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

2 Centre for Health Service Studies, University of Kent, England, UK

3 National Institute for Health and Welfare, Helsinki, Finland

4 Research Unit, Health Environment and Ageing, Sainte Pèrine Hospital APHP and Versailles Saint Quentin University, Paris, France

5 Center for Standard in Health and Disability, Research Authority, Haifa University, Mount Carmel Haifa, Israel

6 Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy

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BMC Health Services Research 2013, 13:138  doi:10.1186/1472-6963-13-138

Published: 15 April 2013



Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. We are, however, still far from being able to refer to a common set of indicators at the European level.

We therefore demonstrate the calculation of Long Term Care Facility Quality Indicators (LTCFQIs) from data of the European

ervices and
ealth for
lderly in
m Care (SHELTER) project. We explain how risk factors are taken into account and show how LTC facilities at facility and country level can be compared on quality of care using thresholds and a Quality Indicator sum measure.


The indicators of Long Term Care Facility quality of care are calculated based on methods that have been developed in the US. The values of these Quality Indicators (QIs) are risk adjusted on the basis of covariates resulting from logistic regression analysis on each of the QIs. To enhance the comparison of QIs between facilities and countries we have used the method of percentile thresholds and developed a QI sum measure based on percentile outcomes.


In SHELTER data have been collected with the interRAI Long Term Care Facility instrument (interRAI-LTCF). The data came from LTC facilities in 7 European countries and Israel. The unadjusted values of the LTCF Quality Indicators differ considerably between facilities in the 8 countries. After risk adjustment the differences are less, but still considerable. Our QI sum measure facilitates the overall comparison of quality of care between facilities and countries.


With quality indicators based on assessments with the interRAI LTCF instrument quality of care between LTC facilities in and across nations can be adequately compared.

Quality indicators; Long term care facility; SHELTER project