Improving the Quality of Care of Long‐Stay Nursing Home Residents in France

Abstract

The aim of the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes (IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home (NH) staff on quality indicators (QIs) and functional decline and emergency department (ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large-scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs.

Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study

“…The study comprised a 6‐month intervention period and an 18‐month follow‐up, and it was designed to improve NH quality indicators related to frequent medical problems faced by NH staff. The full protocol and final results have been described elsewhere . IQUARE followed the principles of the Declaration of Helsinki and complied with ethical standards in France; study protocol was approved by the ethics committee of the Toulouse University Hospital and the Consultative Committee for the Treatment of Research Information on Health (commission nationale de l'informatique et des libertés [CNIL]: 07‐438).…”

Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes

“…Eleven studies were interventional studies with a comparator arm, with quantitative outcome measures, including; 8 randomised controlled trials, all of which were cluster randomised at care home level [ 76 – 83 ]. Four were non-randomised controlled trials [ 84 – 87 ]. Five articles drew comparison between multiple QI initiatives or multiple implementation sites; these papers included reports of characteristics of implementation and descriptive statistics, for example of quality indicators [ 73 – 75 , 88 , 89 ].…”

“…Other studies described components quality improvement, but without specifying a particular strategy. Components included education about clinical conditions or care ( n = 19) [ 28 , 31 , 33 , 36 , 38 , 43 , 46 , 49 , 52 , 55 , 58 , 60 , 65 , 67 – 69 , 83 , 86 , 94 ], care pathway development ( n = 12) [ 31 , 39 , 46 , 55 , 56 , 67 , 73 , 76 , 77 , 85 , 86 , 91 ], audit and feedback ( n = 14) [ 28 , 33 , 37 , 49 , 58 , 61 , 76 , 77 , 81 , 87 , 91 , 93 – 95 ], changes to multidisciplinary team working ( n = 11) [ 28 , 38 , 40 , 41 , 48 , 71 , 79 , 85 – 87 , 95 ], and enabling peers or champions to lead QI initiatives ( n = 10) [ 28 , 36 , 38 , 63 , 65 , 69 , 77 – 79 , 91 ].…”

The role of regulation in the care of older people with depression living in long-term care: a systematic scoping review

“…Murphy et al [26] describe, in positive terms, an intervention in which the Department of Health works alongside nursing homes to develop and implement best practices. Rolland et al [64] examined the effects of an intervention which comprised professional support and education for nursing home staff linked to a range of quality indicators, including functional decline and emergency department transfers of residents. In their study they noted that improved communication and collaboration from the work between geriatricians and nursing home staff, improved problem solving when sharing psychiatric expertise, which ultimately had a positive influence on the care of depression in this population.…”