Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators

Agence Régionale de la Santé - Midi Pyrénées8,039 enrolled

Overview

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

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.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

8,039

Conditions

Interventions

Audit and FeedbackBEHAVIORAL

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.

Cooperative WorkBEHAVIORAL

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.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

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.

Locations (175)

EHPAD le parc ALBI

Albi, France

EHPAD Canarie Vieuzac

Argelès-Gazost, France

MAPAD Les Pradels

Assier, France

Les Jardins auscitains

Auch, France

Les jardins d´Agape

Auch, France

Saint Dominique

Auch, France

Outcomes

Primary Outcomes

Change from baseline in nursing home quality indicators at 18 months

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).

Time frame: baseline and 18-month follow-up

Secondary Outcomes

Onset of dependence in activities of daily living from baseline to 18 months 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".

Time frame: baseline and 18-month follow-up