Dataset Information

Technical-efficiency analysis of end-of-life care in long-term care facilities within Europe: A cross-sectional study of deceased residents in 6 EU countries (PACE).

ABSTRACT:

Background

An ageing population in the EU leads to a higher need of long-term institutional care at the end of life. At the same time, healthcare costs rise while resources remain limited. Consequently, an urgency to extend our knowledge on factors affecting efficiency of long-term care facilities (LTCFs) arises. This study aims to investigate and explain variation in technical efficiency of end-of-life care within and between LTCFs of six EU countries: Belgium (Flanders), England, Finland, Italy, the Netherlands and Poland. In this study, technical efficiency reflects the LTCFs' ability to obtain maximal quality of life (QoL) and quality of dying (QoD) for residents from a given set of resource inputs (personnel and capacity).

Methods

Cross-sectional data were collected by means of questionnaires on deceased residents identified by LTCFs over a three-month period. An output-oriented data-envelopment analysis (DEA) was performed, producing efficiency scores, incorporating personnel and capacity as input and QoL and QoD as output. Scenario analysis was conducted. Regression analysis was performed on explanatory (country, LTCF type, ownership, availability of palliative care and opioids) and case mix (disease severity) variables.

Results

133 LTCFs of only one type (onsite nurses and offsite GPs) were considered in order to reduce heterogeneity. Variation in LTCF efficiency was found across as well as within countries. This variation was not explained by country, ownership, availability of palliative care or opioids. However, in the 'hands-on care at the bedside' scenario, i.e. only taking into account nursing and care assistants as input, Poland (p = 0.00) and Finland (p = 0.04) seemed to be most efficient.

Conclusions

Efficiency of LTCFs differed extensively across as well as within countries, indicating room for considerable efficiency improvement. Our findings should be interpreted cautiously, as comprehensive comparative EU-wide research is challenging as it is influenced by many factors.

SUBMITTER: Wichmann AB

PROVIDER: S-EPMC6155520 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Technical-efficiency analysis of end-of-life care in long-term care facilities within Europe: A cross-sectional study of deceased residents in 6 EU countries (PACE).

Wichmann Anne B AB Adang Eddy M M EMM Vissers Kris C P KCP Szczerbińska Katarzyna K Kylänen Marika M Payne Sheila S Gambassi Giovanni G Onwuteaka-Philipsen Bregje D BD Smets Tinne T Van den Block Lieve L Deliens Luc L Vernooij-Dassen Myrra J F J MJFJ Engels Yvonne Y

PloS one 20180925 9

<h4>Background</h4>An ageing population in the EU leads to a higher need of long-term institutional care at the end of life. At the same time, healthcare costs rise while resources remain limited. Consequently, an urgency to extend our knowledge on factors affecting efficiency of long-term care facilities (LTCFs) arises. This study aims to investigate and explain variation in technical efficiency of end-of-life care within and between LTCFs of six EU countries: Belgium (Flanders), England, Finla ...[more]

PMID: 30252888

Similar Datasets

Project description:BackgroundIn long-term care facilities often many care providers are involved, which could make it difficult to reach consensus in care. This may harm the relation between care providers and can complicate care. This study aimed to describe and compare in six European countries the degree of consensus among everyone involved in care decisions, from the perspective of relatives and care staff. Another aim was to assess which factors are associated with reporting that full consensus was reached, from the perspective of care staff and relatives.MethodsIn Belgium, England, Finland, Italy, the Netherlands and Poland a random sample of representative long-term care facilities reported all deaths of residents in the previous three months (n = 1707). This study included residents about whom care staff (n = 1284) and relatives (n = 790) indicated in questionnaires the degree of consensus among all involved in the decision or care process. To account for clustering on facility level, Generalized Estimating Equations were conducted to analyse the degree of consensus across countries and factors associated with full consensus.ResultsRelatives indicated full consensus in more than half of the residents in all countries (NL 57.9% - EN 68%), except in Finland (40.7%). Care staff reported full consensus in 59.5% of residents in Finland to 86.1% of residents in England. Relatives more likely reported full consensus when: the resident was more comfortable or talked about treatment preferences, a care provider explained what palliative care is, family-physician communication was well perceived, their relation to the resident was other than child (compared to spouse/partner) or if they lived in Poland or Belgium (compared to Finland). Care staff more often indicated full consensus when they rated a higher comfort level of the resident, or if they lived in Italy, the Netherland, Poland or England (compared to Finland).ConclusionsIn most countries the frequency of full consensus among all involved in care decisions was relatively high. Across countries care staff indicated full consensus more often and no consensus less often than relatives. Advance care planning, comfort and good communication between relatives and care professionals could play a role in achieving full consensus.

Project description:BACKGROUND:The technical efficiency (TE) of care among the elderly in long-term care facilities (LTCF) have become increasingly crucial policy concerns faced by developing countries and Asia, especially China. The purpose of this study was to evaluate the TE and the quality of care and identify its influencing factors among LTCF. METHODS:A total of 32 registered LTCF in Xiamen of China were surveyed in 2016. The Banker-Charnes-Cooper (BCC) model and Slacks-Based Measure (SBM) model of Data Envelopment Analysis (DEA) were used to evaluate the TE of LTCF. The TE has been decomposed into pure technical efficiency and scale efficiency. Utilization of DEA with human, financial, and material resources as inputs and quantity, quality of nursing care as outputs allowed estimation of the relative TE of care in LTCF. In addition, this study applied SBM to measuring the efficiencies and slacks. Furthermore, Tobit model was performed to explore factors associated with TE. RESULTS:There were 7 public and 25 private LTCF respectively, with a total of 6729 beds and 3154 elderly people. 17 LTCF were technically efficient (53.1%). In the BCC model, the average TE was 0.963. The average pure technical efficiency and scale efficiency of LTCF were 0.979, 0.984, respectively. There were 5 LTCF with increasing returns to scale, 8 LTCF with decreasing returns to scale. In the SBM model, the average TE was 0.813, and it had the same effective decision-making unit with SBM model. Depending on TE score from high to low, the top eight are private LTCF, and the last four were public LTCF. The slack analysis showed that they can be reduced in 8 LTCF with decreasing returns to scale such as 53.31% administrative staffs, 67.73% medical staffs, 33.1% caregivers, 51.66% paramedical staffs and 4.1% beds on average. The TE of private LTCF was higher than that of public LTCF. The LTCF in urban were more effective than rural. The TE of LTCF raised by increasing of working hours, training frequency and institutional occupancy. CONCLUSIONS:The overall TE of LTCF in Xiamen of China was relatively high, especially in private institutions. However, LTCF still needs to further improve the utilization of physical resources and the management and training of human resources. The TE of LTCF was associated to their location, institutional nature, allocation of human resources and occupancy rate. It was needed to focus on promoting the efficiency and quality of LTCF in order to achieve sustainability.

Dataset Information

Technical-efficiency analysis of end-of-life care in long-term care facilities within Europe: A cross-sectional study of deceased residents in 6 EU countries (PACE).

Background

Methods

Results

Conclusions

Publications

Technical-efficiency analysis of end-of-life care in long-term care facilities within Europe: A cross-sectional study of deceased residents in 6 EU countries (PACE).

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