Home-Based Community Elderly Care Quality Indicators in China: A Systematic Literature Review

Background: China's rapidly aging population has increased the need for effective community-based eldercare services. However, the lack of standardized, culturally relevant evaluation frameworks hinders consistent service quality assessment and improvement. Objective: This systematic review aims to identify, synthesize, and critically evaluate the existing quality indicators (QIs) currently utilized for home-based community elderly care HCEC in China. It also aims to highlight gaps to inform the development of a more comprehensive and context-appropriate quality framework. Methods: Following PRISMA guidelines, systematic searches were conducted across Web of Science, PubMed, Wiley, and CNKI databases for studies published in English and Chinese from 2008 onward. Extracted QIs from eligible studies were categorized using Donabedian's structure-process-outcome (SPO) model. Results: Fifteen studies met the inclusion criteria, with QI sets ranging from 5 to 64 indicators. Most studies emphasized structural and procedural aspects, while outcome measures were limited. Key gaps include inconsistent terminology, insufficient medical care integration, narrow stakeholder engagement, and limited cultural adaptation of Western theoretical frameworks. Furthermore, subjective weighting methods predominated, impacting indicator reliability. Conclusions: Currently, there is no formal quality framework to guide service providers in HCEC, and therefore, quality indicators can be described as fragmented and lack cultural specificity, medical integration, and methodological robustness. Future research should prioritize developing culturally anchored and medically comprehensive QI frameworks, standardize indicator terminology, actively involve diverse stakeholders through participatory methods, and adopt hybrid methodological approaches combining subjective expert insights and objective, data-driven techniques. Alignment with established international standards, such as the OECD long-term care quality indicators, is essential to enhance eldercare quality and support evidence-based policymaking.