M Lagergren1. 1. Ministry of Health and Social Affairs, Stockholm, Sweden.
Abstract
OBJECTIVE: A system for monitoring and evaluating the long-term care of the elderly and disabled is presented, and its problems of completeness, reliability, and validity are discussed. DATA SOURCES/STUDY SETTING: Half-yearly (before 1987) and yearly (after 1987) surveys were taken from 1984 to 1990 of all persons living in the city of Solna, Sweden, who at May 1 and November 1, or November 1, were receiving long-term care services from the municipality or county council, or both. STUDY DESIGN: Completeness of observations was studied by linking survey and admission/discharge observations and checking for breaks in the chain of care. Reliability was estimated by comparing involuntary double registrations. Validity of the chosen measures of need was tested by comparing them with the actual provision of care services. DATA COLLECTION: Registrations concerning actually provided services, assessed need, social environment, and disability were collected on a regular basis by the staff responsible for the care services. PRINCIPAL FINDINGS: Completeness was estimated to be more than 99 percent after a special procedure was carried out for filling in gaps in the "care chain." Reliability testing of the disability measures showed between .69 and .76 Kappa coefficient of agreement. Disability variables were shown to explain 56 percent of variance in the need measure "appropriate level of care." CONCLUSIONS: Tests of completeness, reliability, and validity showed satisfactory results with regard to the purpose of the monitoring system and the limitations inherent in a system intended for routine application.
OBJECTIVE: A system for monitoring and evaluating the long-term care of the elderly and disabled is presented, and its problems of completeness, reliability, and validity are discussed. DATA SOURCES/STUDY SETTING: Half-yearly (before 1987) and yearly (after 1987) surveys were taken from 1984 to 1990 of all persons living in the city of Solna, Sweden, who at May 1 and November 1, or November 1, were receiving long-term care services from the municipality or county council, or both. STUDY DESIGN: Completeness of observations was studied by linking survey and admission/discharge observations and checking for breaks in the chain of care. Reliability was estimated by comparing involuntary double registrations. Validity of the chosen measures of need was tested by comparing them with the actual provision of care services. DATA COLLECTION: Registrations concerning actually provided services, assessed need, social environment, and disability were collected on a regular basis by the staff responsible for the care services. PRINCIPAL FINDINGS: Completeness was estimated to be more than 99 percent after a special procedure was carried out for filling in gaps in the "care chain." Reliability testing of the disability measures showed between .69 and .76 Kappa coefficient of agreement. Disability variables were shown to explain 56 percent of variance in the need measure "appropriate level of care." CONCLUSIONS: Tests of completeness, reliability, and validity showed satisfactory results with regard to the purpose of the monitoring system and the limitations inherent in a system intended for routine application.