Work

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

Year: 2026

Type: article

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; p unadjusted = 0.033, p = 0.144), a lower probability of premature death from cardiovascular disease, cancer, diabetes and chronic respiratory diseases (−3.33 percentage points; p unadjusted = 0.049, p = 0.144), and reduced under-five mortality (−4.06 deaths per 1,000 live births; p unadjusted = 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; p unadjusted = 0.043, p = 0.167) and lower under-five mortality (−0.72 deaths per 1,000 live births per additional policy; p unadjusted = 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.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1904393