Quality of Longer Term Mental Health Facilities in Europe: Validation of the Quality Indicator for Rehabilitative Care against Service Users’ Views

Abstract

BackgroundThe 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.MethodAt 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.Results1750/2495 (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.ConclusionsRatings 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.

Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users’ engagement in activities

“…Most (52/60) NHS Trusts participated, comprising a total of 133 mental health inpatient rehabilitation units. These units were assessed using the Quality Indicator for Rehabilitative Care (QuIRC), an international, standardised quality assessment tool completed by the unit manager [24], [25]. Units scoring below the median on the total QuIRC score were eligible for inclusion in the trial.…”

“…vi) service quality as assessed using the Quality Indicator for Rehabilitative Care (QuIRC) [24], [25]. This tool comprises 145 questions on service quality and provision (e.g.…”

Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: a national survey

“…Service quality was assessed using the Quality Indicator for Rehabilitative Care -Supported Accommodation (QuIRC-SA) which rates seven domains: living environment; therapeutic environment; treatments and interventions; self-management and autonomy; social interface; human rights; recoverybased practice [12,13].…”

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

“…6. Service quality was assessed using the QuIRC, 43,44 which was completed by the unit manager. This tool comprises 145 questions on service quality and provision.…”

“…Data were gathered on service user participants at recruitment from a review of case notes and staff-rated measures, as follows: demographics (age, sex, ethnic group); diagnosis; length of history; length of current admission; previous admissions; previous involuntary admissions; risk history; social function, assessed using the LSP; 75 engagement in activities, assessed using the staff-rated version of the time-use diary; 74 and function, assessed using the GAF scale. 50 Potential mediators of outcomes were also assessed through staff ratings: quality of care in the unit was assessed using the QuIRC 43,44 completed by the unit manager; staffing of the unit and the availability of specific interventions were included in the QuIRC; service users' substance use was assessed using the Clinician Alcohol and Drug Use Scales; 76 and challenging behaviours that may make community placement difficult were assessed using the SPRS. 77 At the 12-month follow-up, the researchers contacted a key informant to clarify whether or not the service user had been successfully discharged, and the details of community placements were recorded.…”