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

Study Overview
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Brief Summary
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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 Residents: Functional decline rate Drug prescriptions (quantity and quality) Prevalence of adverse health outcomes (e.g., falls) NHs: Planning and implementation of therapeutic measures

Detailed Description
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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.

Official Title
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Impact of Either Audit and Feedback Only or Audit and Feedback Associated to Cooperative Work Meetings Between Hospital Geriatricians and Nursing Home Staff on Quality Indicators and Health Care Practices in Nursing Homes.

Conditions
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Quality Indicators, Physical Disability

Intervention / Treatment
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* Behavioral: Audit and Feedback
* Behavioral: Cooperative Work


Participation Criteria
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Eligibility Criteria
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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.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: strong intervention group (SIG)<br>Nursing homes that received audit and feedback information on quality indicators and benefited of cooperative work meetings with hospital geriatricians | Behavioral: Audit and Feedback<br>* 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.<br>Behavioral: Cooperative Work<br>* 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.<br>|
| Active Comparator: intervention group (LIG)<br>Nursing homes that only received audit and feedback information on quality indicators | Behavioral: Audit and Feedback<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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). | baseline and 18-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | baseline and 18-month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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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