Long-term care: variations on a quality assurance theme.

Quality assurance in long-term care (LTC) diverges from approaches in acute care because of inherent features of LTC: the slower pace, the reliance on "low technology" services, the goals of LTC, and the multiple transitions across care sites typical of LTC users. LTC quality assurance activities should focus on outcomes, using process measures only when they are related to desirable outcomes or are intrinsic to respectful treatment of patients. Outcome measures should compare what is achieved with what can be reasonably expected. Because LTC services can be given interchangeably at various LTC sites (e.g., home care, day care, nursing homes), a data base must be developed that permits monitoring and comparing outcomes across diverse LTC programs.