Quality Indicators, Physical Disability
Conditions
Keywords
Quality indicators, quality of care, nursing home, long-term care unit, nursing home organisation, nursing home structure, disability, dependence, functional decline, functional impairment, older adults, elderly, audit and feedback, cooperative work, geriatrician, medication, hospitalisation, comorbidity
Brief summary
Introduction: Efficacy of audit and feedback interventions on nursing home (NH)quality indicators is not well-established. The main objective: The main purpose of the IQUARE study was to examine the impact of two types of audit and feedback interventions on NH quality indicators and on residents dependence levels in a 18-month follow-up. Study hypothesis: We hypothesised that audit and feedback associated to educational and professional supportive interventions are more efficacy in improving NH quality indicators than audit and feedback only. Secondary objectives: Investigate the impact of the interventions on 1. Residents: * Functional decline rate * Drug prescriptions (quantity and quality) * Prevalence of adverse health outcomes (e.g., falls) 2. NHs: * Planning and implementation of therapeutic measures
Detailed description
IQUARE is a multicentric individually-tailored controlled trial comparing two types of audit and feedback interventions: * audit and feedback associated to cooperative work meetings between hospital geriatricians and nursing home (NH) staff in a 6-month intervention (strong intervention) * audit and feedback only (light intervention) Power statistics and sample size calculations indicated that each group should be composed of at least 2 500 individuals. The strong intervention will last 6 months and is composed of two face-to-face cooperative meetings (hospital geriatricians and NH staff). Data will be collected at baseline and in a 18-month follow-up.
Interventions
BEHAVIORALAudit and Feedback
Descriptive statistics to each nursing home (NH) with regards to its own indicators of quality and residents' health status, and the same descriptive statistics on the sub-regional and regional levels were done to all NHs for comparative purposes.
BEHAVIORALCooperative Work
Nursing homes (NH)in the strong intervention group had two half-day meetings of cooperative work with a hospital geriatrician to identify NHs' weaknesses regarding quality of care and to establish strategies for overcoming these weaknesses.
Sponsors
Observatoire Régional de la Santé Midi-Pyrénées (ORSMIP)
Agence Régionale de la Santé - Midi Pyrénées
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Nursing homes (NH) voluntarily accepted to participate in the study. * NH residents of both sex * Residents living in the NH for ≥ 30 days * Residents and their general practitioner (GP) having received information about the study * NH residents do not voluntarily decline to participate in the study
Exclusion criteria
* NH currently participating in another interventional study * GP of NH residents refused participation in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in nursing home quality indicators at 18 months | baseline and 18-month follow-up | Indicators of quality of care in 10 main outcomes: dementia (e.g.,prevalence of cognitive assessment), behavioural disturbances (e.g., prevalence of behavioural disturbances assessment), restraining (e.g., prevalence of restrained residents with a medical prescription for restraining), mood (e.g., prevalence of mood assessment), osteoporosis and falls (e.g., systematic analysis of fall records), nutrition (e.g., prevalence of residents who were weighed ≥ 3 times in the last 3 months), pressure ulcers (e.g., prevalence of residents who were evaluated for the risk of pressure ulcers), pain (e.g., prevalence of residents who were evaluated for pain among residents in end-of-life), medication (e.g., prevalence of re-evaluation of residents' drug prescriptions among residents who take psychotropic), and care and services (e.g., prevalence of hospitalisations in the emergency department in the last 12 months). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Onset of dependence in activities of daily living from baseline to 18 months follow-up | baseline and 18-month follow-up | Onset of dependence will be measured using the 6-item Katz ADL scale. Activities examined are: bathing, dressing, transferring, walking inside home, incontinence, and eating/drinking. Ability in executing each activity will be set as: able to execute alone, without difficulty, able to execute alone, with some difficulty, or needing help to execute or unable to execute. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Reduction in the prescription of psychotropic drugs from baseline to 18-month follow-up | baseline and 18-month follow-up | It will be examined if the rate of antidepressants, anxiolytics, antipsychotics, and hypnotics/sedatives (coded according to the Anatomical Therapeutic Chemical classification. Information available at: http://www.whocc.no/atc\_ddd\_index/) prescriptions will be reduced between baseline and follow-up. A particular attention will be given to the prevalence of people taking 3 or more psychotropics (increased risk of drug-drug interaction and adverse drug reaction) and to the use of these medications among people with dementia. |
Countries
France
Outcome results
None listed