Do self-reported 'integrated' continence services provide high-quality continence care?

Abstract

Introduction: systematic collection of clinical outcome data remains the most difficult task in the measurement of clinical effectiveness. However, the examination of the relationship between organisational and clinical process of care may provide a surrogate measure of quality in care. Methods: data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. 'Quality' scores were produced and the relationship between scores was examined. Results: there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45-68) vs 48 (36-65) vs 50 (38-55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32-52) vs 40 (29-49) vs 43 (34-52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34-53) vs 45 (36-55) vs 47 (41-53), P = 0.12]. Conclusion: those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care. © The Author 2009. Published by Oxford University Press [on behalf of the British Geriatrics Society]. All rights reserved.