Introduction: In recent years, the Dutch Health and Youth Care Inspectorate (IGJ) has laid the foundation for inspecting care networks supporting clients with multiple care needs. It is expected that well-functioning care networks for clients living in the home environment will increase in importance because people stay at home as long as possible. Inspection of care networks by IGJ is area-based: network care is investigated in selective municipalities. However, these municipalities are not yet selected on the basis of risks.
Policy context and objective: The general policy of IGJ is that inspections should be conducted in municipalities where the risks of poor quality network care are highest. This raises the question of which indicators can be used as proxies of quality. The objective of this project is to find such indicators.
Targeted population: Frail elderly people living at home in the Netherlands. This group is expected to grow from 700,000 in 2010 to 1 million in 2030.
Highlights: The project has resulted in four feasible proxy indicators: 1. Rehospitalizations: this could be a signal that the care at home has not been adjusted to any change to the needs of the frail elderly person. 2. Unexpectedly long hospital stay: this could indicate that there is no suitable place for the inpatient to go to, perhaps because the care needed at home cannot be arranged. 3. Overburdening of informal caregivers: this could be a signal that the care network does not sufficiently support the informal caregiver. 4. Acute situations: frequent emergency attendances of frail elderly people could indicate that the care at home is inappropriate.
This is the first project in which IGJ attempts to identify proxy indicators for a risk-based selection of municipalities. In these municipalities should inspection of care networks be prioritized.
Comments and transferability: The indicators are no direct measures of the quality of network care, but they can signal quality indirectly. The value of these indicators needs to be tested in practice.
Furthermore, the indicators cannot give a complete picture of all levels of integration. They only give information on the quality of integrated care at a clinical level. They can, however, indicate certain quality aspects on an organizational level.
Care networks are still being developed and can be organized in various ways. IGJ should therefore maintain flexibility and take care not to impose rigid rules or frameworks that could hinder innovation.
Conclusions: The above indicators enables the first steps in a risk-based selection of municipalities. The use of multiple indicators means that different aspects of care networks are represented. The indicators need to be validated to see if they really represent the quality of care networks.