The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

Abstract

BackgroundDespite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted.MethodThe domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion.ResultsThe toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care.ConclusionsTriangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.

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

“…Our sample size (133 units) allowed us to estimate up to eight coefficients in each model, using the rule of 15 observations per coefficient estimated to achieve adequate precision. The covariates selected a priori were location of unit (hospital or community; units within hospital grounds were recategorised as community, as previously they were found to be more similar in profile to community-based units than to hospital wards); 43 psychiatric morbidity of the area local to the unit; percentage of male service users; mean age of service users; service users' mean GAF score; and percentage of service users detained involuntarily.…”

“…To assess the strength of the association between the quality of care as assessed by the QuIRC 43 and staffing levels, product-moment correlation coefficients were calculated. Moreover, we explored the association between service user characteristics and the number of self-reported contacts with the four aforementioned 'core' professional disciplines in a complete case analysis.…”

“…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.…”

“…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.…”