Methodological evaluation of the psychometric properties of medication-related quality indicators in residential aged care homes: a systematic review

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BACKGROUND: Quality indicators (QIs) are important for tracking and enhancing healthcare quality. In residential aged care homes (RACHs), medication-related QIs help ensure the quality of medication usage and patient care. To ensure the effective use of QIs, it is essential that they are reliable and satisfy other psychometric properties. This study explored the psychometric properties, including validity, reliability, feasibility, applicability, sensitivity, measurability, appropriateness, and usefulness, of medication-related QIs used in RACHs, as well as the methodologies employed in studies evaluating these QIs. METHODS: A systematic search was conducted using CINAHL, MEDLINE, PsycINFO, Scopus, and Web of Science Core Collection, covering studies published since inception until December 2025. Covidence software was used for title and abstract screening and full-text reviewing. Medication-related QIs, psychometric properties evaluated, and the employed methodology were extracted from the studies and were critically analyzed to provide an understanding of current QI evaluation techniques. RESULTS: The search identified 15 247 studies. After removing duplicates and applying inclusion/exclusion criteria, 21 full-text studies were included, with an average methodological quality score of 60% based on the Mixed Methods Appraisal Tool. Psychotropic drug use and polypharmacy were commonly tested medication-related QIs. Validity (reported in 12 studies), reliability (in 9 studies), and feasibility (in 8 studies) were the most frequently assessed psychometric properties. The Delphi method was the primary approach for validity and feasibility testing. CONCLUSIONS: There were inconsistencies among the methods used for testing the psychometric properties of the QIs. This highlights the need for a standardized protocol for testing medication-related QIs for use in aged care to ensure their reliability and effectiveness.

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