Use of quality-of-care and patient-safety policies in the WHO European region: an ecological cross-sectional exploratory analysis of policy adoption and health outcomes
- 1Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Naples, Italy
Abstract
Objective: To assess the implementation of quality-of-care and patient-safety policies across the WHO European Region and their association with population health outcomes.
Methods: This study used an exploratory, ecological cross-sectional design. We constructed a summary count (0–9) of nine national quality-of-care and patient-safety policies to capture the breadth of policy adoption, and used exploratory multivariable linear regression to examine cross-sectional associations with selected outcomes, adjusting for health-workforce density and public spending on health.
Results: Many countries lacked national action plans for quality and patient safety, with only around one-third implementing both. Implementation of a national quality-of-care plan was associated with higher healthy life expectancy (1.68 additional years; punadjusted = 0.033, p = 0.144), a lower probability of premature death from cardiovascular disease, cancer, diabetes and chronic respiratory diseases (−3.33 percentage points; punadjusted = 0.049, p = 0.144), and reduced under-five mortality (−4.06 deaths per 1,000 live births; punadjusted = 0.023, p = 0.144). Implementing a greater number of national policies was associated with small increases in healthy life expectancy (0.29 years per additional policy; punadjusted = 0.043, p = 0.167) and lower under-five mortality (−0.72 deaths per 1,000 live births per additional policy; punadjusted = 0.018, p = 0.162), while associations with other outcomes were weaker and often non-significant.
Conclusion: Given the ecological cross-sectional design, limited adjustment and multiple testing, these findings should be treated as exploratory and non-causal and used as a basis for more detailed longitudinal research.
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BibTeX
@article{borgermans2026qualityofcare,
title = {{Use of quality-of-care and patient-safety policies in the WHO European region: an ecological cross-sectional exploratory analysis of policy adoption and health outcomes}},
author = {Liesbeth Borgermans and Ana Marques Domingues and Anna Crispo and Válter R. Fonseca and Lenio Capsaskis and Jennifer Hall and João Breda},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1904393},
url = {https://doi.org/10.3389/fpubh.2026.1904393},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Use of quality-of-care and patient-safety policies in the WHO European region: an ecological cross-sectional exploratory analysis of policy adoption and health outcomes
AU - Liesbeth Borgermans
AU - Ana Marques Domingues
AU - Anna Crispo
AU - Válter R. Fonseca
AU - Lenio Capsaskis
AU - Jennifer Hall
AU - João Breda
PY - 2026
DA - 2026/10/12
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1904393
UR - https://doi.org/10.3389/fpubh.2026.1904393
AB - Objective: To assess the implementation of quality-of-care and patient-safety policies across the WHO European Region and their association with population health outcomes. Methods: This study used an exploratory, ecological cross-sectional design. We constructed a summary count (0–9) of nine national quality-of-care and patient-safety policies to capture the breadth of policy adoption, and used exploratory multivariable linear regression to examine cross-sectional associations with selected outcomes, adjusting for health-workforce density and public spending on health. Results: Many countries lacked national action plans for quality and patient safety, with only around one-third implementing both. Implementation of a national quality-of-care plan was associated with higher healthy life expectancy (1.68 additional years; punadjusted = 0.033, p = 0.144), a lower probability of premature death from cardiovascular disease, cancer, diabetes and chronic respiratory diseases (−3.33 percentage points; punadjusted = 0.049, p = 0.144), and reduced under-five mortality (−4.06 deaths per 1,000 live births; punadjusted = 0.023, p = 0.144). Implementing a greater number of national policies was associated with small increases in healthy life expectancy (0.29 years per additional policy; punadjusted = 0.043, p = 0.167) and lower under-five mortality (−0.72 deaths per 1,000 live births per additional policy; punadjusted = 0.018, p = 0.162), while associations with other outcomes were weaker and often non-significant. Conclusion: Given the ecological cross-sectional design, limited adjustment and multiple testing, these findings should be treated as exploratory and non-causal and used as a basis for more detailed longitudinal research.
SN - 2296-2565
ER -