Quality of Care Indicators for People With Dementia: An Umbrella Review

BACKGROUND: Monitoring the dementia care quality is key for healthcare services. Dementia care quality indicators (QIs) have been reported in the literature, fragmented by setting or stage of care. We aimed to conduct an umbrella review (review of systematic reviews) to identify, evaluate, and summarize dementia care QIs throughout the disease trajectory. METHODS: We conducted an umbrella review reporting the development, review, or testing of dementia care QIs. We used a structured search in MEDLINE (Ovid), PsycINFO (EBSCO), Cochrane Library, and LILACS. Two researchers independently screened titles, abstracts, and full-texts. QIs from included articles were extracted by one reviewer and checked by a second one. The AMSTAR 2 and AIRE tools were used to assess the methodological quality of reviews and QIs, respectively. Included QIs were categorized and coded based on their stage of care (initial assessment after diagnosis, follow-up and treatment, and end-of-life), type of indicator (structure, process, outcome), and specific aspects of care measured. RESULTS: Six systematic reviews were included, comprising 554 dementia care QIs that were synthesized into 120 QIs. 86 (72%) were classified as process, 20 (16%) as structure, and 14 (12%) as outcome indicators. 32 QIs (27%) are recommended exclusively for community settings, 7 (6%) for hospital settings, and 81 (67%) for more than one care setting. The 120 QIs are related to 60 different aspects of care, with advanced care planning and having an individualized healthcare plan being the most frequently quoted QIs. The quality of systematic reviews was low to critically low, and over a third of QIs were considered to have high methodological quality. CONCLUSIONS: Our umbrella review synthesized a broad overview of dementia care QIs, facilitating healthcare organizations to monitor and improve areas in need. Future research should focus on validating these QIs in local contexts.