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The RAF method for regulation, assessment, follow‐up and continuous improvement of quality of care was developed in Israel in the late 1980s by the Quality of Care Unit at the JDC‐Brookdale Institute. The goal of the RAF method is to continuously increase the level of quality in organizations providing any kind of a service. This article presents the developmental processes for the method’s adaptation to a specific regulatory service – its structuring, implementation and assimilation – based on our experience in developing and implementing the RAF method in Israel. It describes how the RAF method encourages the development of reliable data bases, adaptation of the organizational structure, and introduction of a positive ideology that together promote changes leading to continuous improvement in quality of care.

Attention has been increasingly devoted to the development of methods for assessing the quality of care in long‐term care (LTC) facilities, especially for government surveillance. A study is described which used the tracer method to provide data on the quality of care in Israeli LTC institutions. Advantages of the tracer method include its incorporation of structural, process and outcome measures and its focus on a number of representative tracer conditions. The study tested the ability of the tracer method to provide data on the quality of care, and facilitated adoption of this methodology by the government for their annual inspections.

Explains the conceptual framework behind and the foundation and implementation of the regulation, assessment, follow‐up (RAF) method, and continuous improvement of quality of care in the Israeli Government surveillance of long‐term care institutions. The RAF method has made crucial changes in the goals, tasks and tools of surveillance and in therapeutic approaches to the elderly. The “maintenance approach” has been replaced by a “rehabilitative approach” bringing about a real improvement in the quality of care in institutions. Presents selected findings from an evaluation of the RAF method’s use in the surveillance system operated by the Israeli Service for the Aged of the Ministry of Labor and Social Affairs.

This article describes actual UI prevalence and quality of care at Israeli LTC institutions for the elderly. The analysis is based on current regulatory data on 14,406 residents at 196 residential homes, and 8,278 patients at 159 hospitals for the chronically ill. It includes a calculation of summary indices of quality, the percentage of institutions with deficient items and of those showing change, and a description of functional status profiles. Multiple regression explains the deficiency rate variance through independent institutional variables. There is a higher prevalence of severe functional impairment and full incontinence at hospitals for the chronically ill than at residential homes. There were higher rates of deficiencies and lower rates of corrections for structural items than for process items at both. A major improvement occurred for process items (50‐100 per cent). Regarding outcomes, 34 percent of the residents with UI during the first assessment were continent two years later.

The RAF method for regulation, assessment, follow‐up and continuous improvement of quality of care was developed in Israel in the late 1980s by the Quality of Care Unit at the JDC‐Brookdale Institute. During the past decade the RAF method has been adapted to and implemented successfully in a number of government regulatory systems operated by services in the Ministry of Health and the Ministry of Labor. This article presents the conceptual framework of the RAF method. It describes the three theoretical approaches that have been integrated – the tracer approach, the model for quality assurance and the introduction of organizational change – to create a broad conceptual framework. It then presents the key operational principles at work in the field that drive the RAF mechanism in its efforts to achieve a constant improvement in quality of care.

In Israel, institution staff classify residents’ functional status as part of the routine governmental surveillance of institutions for semi‐independent and frail elderly. However, owing to a lack of clarity and specificity in the regulation which defines functional status categories, nurse surveyors, who conduct the routine surveillance of institutions, have begun to make their own estimates of functional status. Data were collected and compared on the functional status classification of 78 per cent of the elderly residents by institution staff and nurse surveyors. Data analysis showed that the poorer the functional status, the less congruity between the classifications. This has practical consequences for estimating the number and type of staff needed. It was found that the waste of resources and discrepancies caused by reclassification of the elderly by the nurse surveyors may be avoided by using more specific and precise definitions as suggested in this article.

Describes a methodological study to evaluate the quality of care for an elderly population in the treatment of hypertension from a fairly simple analysis of medical records in primary care, with or without the use of additional information from patients, and shows how this type of data can be used to point out shortcomings in primary care. The data derive from a community survey of elderly people in one area of Jerusalem and relied on personal interviews, blood pressure measurements and an analysis of medical records over a period of four years. The measures used are: the percentage of persons without blood pressure (BP) measurement in a given year; the maximum “gap” between consecutive BP measurements in a given year; the rate of BP measurement per clinic visit; the percentage of hypertensives treated; and the percentage of hypertensives under control. The prevalence rates for hypertension in this elderly population vary between 40 per cent and 59 per cent according to the definition used. Using a simple and straightforward analysis of sick‐fund records several shortcomings in the surveillance and control of hypertension were detected. Calculation of the percentage of untreated hypertensives required a separate information source ‐ the screening. A BP survey is an important complement to an analysis of records. An ongoing evaluation of the quality of care of hypertensives in an elderly population should be based on screening, interviews with patients and analysis of the physician′s records. These provide an overall picture of the care in each medical practice enabling the physician to improve the quality of care provided to his or her patients.

A method for the regulation, assessment, follow‐up and continuous improvement of care in long‐term care institutions – the RAF method – was developed by a team of researchers at the JCD‐Brookdale Institute. It was tested in a five‐year experimental programme, implemented in the surveillance systems operated by the Ministry of Labor and Social Affairs and the Ministry of Health. The programme, which introduced major changes into the surveyors’ work practices, included workshops for the surveyors and collaboration between surveyors and researchers to solve problems which arose during the development phase of the programme. Based on the experimental programme’s success in identifying and correcting deficiencies in the care of residents in long‐term care institutions, the RAF method was implemented in Government regulatory systems on a regular basis, nationwide, beginning in 1993.

As part of the evaluation of an experimental programme of surveillance of institutions for the semi‐independent and frail elderly using the RAF method, an examination was made of the licensing status, quality of care, and completeness of the surveillance process. Included in the examination were 126 institutions which underwent the surveillance process between 1990 and 1993. Aims to investigate whether the RAF method of surveillance was being implemented in a professional and uniform manner. Concludes that surveyors’ recommendations to grant or not grant a licence were usually based on findings about the quality of care. Nevertheless, in order to reinforce the relationship between licensing and quality of care, it was suggested that surveyors be given clear criteria of quality on which to base their recommendations regarding conditional licensing. It was found that the surveillance process is indeed implemented uniformly in long‐term care institutions of varying quality.