Quality improvement studies in nursing homes: a scoping review

Abstract

Background Quality improvement (QI) is used in nursing homes (NH) to implement and sustain improvements in patient outcomes. Little is known about how QI strategies are used in NHs. This lack of information is a barrier to replicating successful strategies. Guided by the Framework for Implementation Research, the purpose of this study was to map-out the use, evaluation, and reporting of QI strategies in NHs. Methods This scoping review was completed to identify reports published between July 2003 through February 2019. Two reviewers screened articles and included those with (1) the term “quality improvement” to describe their methods, or reported use of a QI model (e.g., Six Sigma) or strategy (e.g., process mapping) (2), findings related to impact on service and/or resident outcomes, and (3) two or more NHs included. Reviewers extracted data on study design, setting, population, problem, solution to address problem, QI strategies, and outcomes (implementation, service, and resident). Vote counting and narrative synthesis were used to describe the use of QI strategies, implementation outcomes, and service and/or resident outcomes. Results Of 2302 articles identified, the full text of 77 articles reporting on 59 studies were included. Studies focused on 23 clinical problems, most commonly pressure ulcers, falls, and pain. Studies used an average of 6 to 7 QI strategies. The rate that strategies were used varied substantially, e.g., the rate of in-person training (55%) was more than twice the rate of plan-do-study-act cycles (20%). On average, studies assessed two implementation outcomes; the rate these outcomes were used varied widely, with 37% reporting on staff perceptions (e.g., feasibility) of solutions or QI strategies vs. 8% reporting on fidelity and sustainment. Most studies (n = 49) reported service outcomes and over half (n = 34) reported resident outcomes. In studies with statistical tests of improvement, service outcomes improved more often than resident outcomes. Conclusions This study maps-out the scope of published, peer-reviewed studies of QI in NHs. The findings suggest preliminary guidance for future studies designed to promote the replication and synthesis of promising solutions. The findings also suggest strategies to refine procedures for more effective improvement work in NHs.

Interventions to promote the implementation of pressure injury prevention measures in nursing homes: A scoping review

“…In the US, 15,600 nursing home staff care for approximately 1.3 million seniors per day (Harris-Kojetin et al, 2016). In addition to housing, three meals a day, and personal care, the nursing homes also provides specialist caring, 24-h supervision, and rehabilitation services (Toles et al, 2021), which are Thus, the real effectiveness of these interventions was unclear.…”

Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

“…Few multi-component interventions or studies specifically referred to as quality improvement (QI) studies conducted in NHs examine the relationship between implementation fidelity and its influence on clinical outcomes (e.g., unplanned hospital transfers) [23]. Only 3% of NH QI studies report fidelity, however QI guidelines do not emphasize reporting this outcome [24]. The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement (QI) program was the first initiative to develop a bundle of tools that can be implemented in NHs to drive staff clinical reasoning and communication with the goal of reducing avoidable hospitalisations [4].…”

Expanded role of nurses in Swiss nursing homes and their engagement in quality improvement: A cross‐sectional study

“…To meet these challenges, implementing quality improvement is key: it can help NHs identify problems, initiate improvement cycles and evaluate outcomes (Johannessen et al, 2020; OECD/European Union, 2013;Rantz et al, 2012).Quality improvement activities include, for example, monitoring, benchmarking and assessing data, evaluating processes, identifying opportunities for improvement, implementing new approaches to care, and assessing changes in processes or outcomes. Various publications have reported on specific NH quality improvement interventions or projects (Chadborn et al, 2020;Toles et al, 2021). However,…”

“…Quality improvement activities include, for example, monitoring, benchmarking and assessing data, evaluating processes, identifying opportunities for improvement, implementing new approaches to care, and assessing changes in processes or outcomes. Various publications have reported on specific NH quality improvement interventions or projects (Chadborn et al, 2020;Toles et al, 2021). However,…”