Defining quality of healthcare in Dutch police custody: the development of a conceptual framework for monitoring care quality through a scoping review and expert consultations.

Background
Individuals in police custody may require medical attention, yet little is known about the quality of care in police custody. Research is lacking on appropriate standards and indicators for measuring care quality. This study aimed to develop a conceptual framework to identify key aspects for measuring the quality of care in police custody in the Netherlands.

Methods
A scoping review supplemented by expert consultations was conducted to gather information on health needs and quality of care in short-term police custody settings. Searches were performed across seven electronic databases (Embase, Medline, PsycInfo, CINAHL, Criminal Justice Abstracts, PiCarta, and Cochrane) for articles published in English or Dutch between 2008 and February 2023, and were supplemented with Dutch documents of medical guidelines, protocols, work instructions, and additional grey literature. An initial conceptual framework was developed from the literature review and author expertise, which was subsequently discussed and validated by field experts through two expert consultation group meetings.

Results
This study included 69 scientific articles, 17 medical guidelines, protocols and work instructions, and 12 reports, alongside consultation with 27 experts. The resulting conceptual framework applies a structure-process-outcome model to evaluate the care quality in police custody, organized into 14 domains. At the structure level, it includes the scope and nature of care demand, (healthcare) staff, the legal framework, quality assurance, infrastructure and (medical) resources, and funding. The process level covers triage and access to healthcare, detection of care needs, continuity of healthcare information, coordination of care, general healthcare provision, and healthcare provision for common needs. The outcome level addresses effectiveness and health outcomes, and satisfaction. These domains are further classified into 48 subdomains. There were no existing indicators identified in the literature to populate the framework.

Conclusions
The conceptual framework outlines key domains for measuring quality of care in Dutch police custody. Future research will be necessary to populate the framework with indicators to monitor quality of care and support improvement efforts tailored to the needs of specific stakeholders. The operationalization and implementation of the framework will be vital for improving the care provided within police custody.