Mental Health-Related Quality Indicators for Long-Term Care: A Modified Delphi Consensus Study

Despite the high prevalence of depression, anxiety, and other mental health conditions in long-term care settings, there are no mental health-related quality indicators mandated for use in Australia. This study aimed to gain national consensus on indicators for inclusion in a mental health benchmarking industry tool for residential aged care.

A modified Delphi study incorporating 2 rounds of online surveys.

We invited a panel of clinical, academic, industry, and consumer experts from across Australia.

Experts were asked to rate 35 potential indicators on a 5-point Likert scale for importance and feasibility. Round 2 included new potential indicators based on qualitative feedback, and merged or reworded indicators that did not previously achieve consensus. Indicators with a median rating ≥4 and an interquartile range ≤1 for importance were deemed acceptable. Additional steering group meetings were held between rounds, for decision-making purposes.

Rounds 1 and 2 were completed by 49 and 34 experts, respectively. Twenty-seven indicators achieved consensus of agreement for inclusion on importance, with good to excellent item content validity. These included 6 items relating to assessment, 7 items relating to management, 4 items relating to resources, 5 items relating to staff training, and 5 items relating to resident outcomes. Although these indicators also rated highly on feasibility, there was mixed consensus as measured by an interquartile range >1. Qualitative feedback suggests that the indicators are comprehensive, important, and valuable.

Findings provide consensus on a mix of structure (staff training and resources), process (assessment and management), and resident outcome quality indicators. Future research will focus on pilot testing the indicators in residential aged care homes, to ensure and optimize feasibility, reliability, acceptability, and case-mix adjustment considerations. The mental health benchmarking tool has the potential to drive mental health care improvements at both a care home and industry level, in Australia and globally.