Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views

• Published in: PloS one 2012-06, Vol.7 (6), p.e38070-e38070
• Main Authors: Killaspy, Helen, White, Sarah, Wright, Christine, Taylor, Tatiana L, Turton, Penny, Kallert, Thomas, Schuster, Mirjam, Cervilla, Jorge A, Brangier, Paulette, Raboch, Jiri, Kalisova, Lucie, Onchev, Georgi, Alexiev, Spiridon, Mezzina, Roberto, Ridente, Pina, Wiersma, Durk, Visser, Ellen, Kiejna, Andrzej, Piotrowski, Patryk, Ploumpidis, Dimitris, Gonidakis, Fragiskos, Caldas-de-Almeida, José Miguel, Cardoso, Graça, King, Michael
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Aged; Aged, 80 and over; Analysis; Autonomy; Dependent variables; Education; Epidemiology; Europe - epidemiology; Female; Health aspects; Health care; Health care facilities; Health centres; Health Facilities - standards; Health Facilities - statistics & numerical data; Health sciences; Health services; Hospital facilities; Hospitals; Human rights; Humans; Independent variables; Intellectual disabilities; Literature reviews; Long-Term Care - standards; Long-Term Care - statistics & numerical data; Male; Medical care quality; Medical ethics; Medical research; Medicine; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - rehabilitation; Mental health; Mental Health Services - standards; Mental Health Services - statistics & numerical data; Mental Health Services - utilization; Middle Aged; Multilevel; Population; Psychiatrists; Psychiatry; Psychotherapy; Quality control; Quality Indicators, Health Care - standards; Quality Indicators, Health Care - statistics & numerical data; Quality of life; Ratings; Rehabilitation; Reproducibility of Results; Research methodology; Studies; User satisfaction; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0038070

The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.