Table 2 Study Characteristics (N = 59 studies)
From: Quality improvement studies in nursing homes: a scoping review
Papers | Setting | Problem | Project or Study Name | QI Strategies (count) | Implementation Outcomes (type) | Outcomes S = p < .05, NS = p ≥ .05, NR = S not reported | |
|---|---|---|---|---|---|---|---|
Service | Resident | ||||||
Primary study design: Cluster randomized and controlled trial (includes between group differences in service and resident outcomes) | |||||||
Boyd, 2014 [61] | New Zealand, 29 NHsa | Hospital transfers | Residential Aged Care Integration Program | 5 | • Adoption • Reach to staff | none | Falls rate increased overall but less in Intvn.b group S |
Bravo, 2005 [62] | Canada, 40 NHs | Quality of care | none | 6 | • Adoption | Quality of care scores NS | none |
Colon-Emeric, 2007 [63] | US, 67 NHs | Falls and fractures | none | 4 | • Adoption • Reach to residents | Use of hip protectors and pharmacotherapy NS | Falls rate NS |
Colon-Emeric, 2013 [64] | US, 8 NHs | Falls | CONNECT for Quality | 9 | • Reach to staff • Reach to residents | • Communication and safety culture scores S • Falls risk reduction activities NS | none |
US, 24 NHs | Falls | CONNECT for Quality | 9 | • Reach to staff and residents • Sustainment | Falls risk reduction activities NS | Falls rate NS | |
Crespy, 2016 [66] | US, 37 NHs | Symptoms of depression | Promoting Positive Well-Being | 5 | • Adoption • Reach to staff • Perceptions | none | Rate of symptoms of depression S |
Kane, 2017 [67]; Huckfedlt, 2018 [68]; Tappen, 2018 [69]; Tappen, 2017 [70] | US,85 NHs | Hospital transfers | INTERACT | 8 | • Adoption • Reach to residents • Perceptions | Rate staff used tools for monitoring and communicating changes in health NR | • Hospital transfers NS • In NHs with high tool use, hospital transfers S |
Kennedy, 2015 [71]; Kennedy, 2014 [72] | Canada, 12 NHs | Osteo-porosis and fractures | Vitamin D and Osteo-porosis Study | 8 | • Adoption • Reach to staff and residents | • Vitamin D and Calcium prescribing S • Osteoporosis medication prescribing NS | none |
Nace, 2011 [73] | US, 6 NHs | Immuni-zation | none | 5 | • Reach to residents | Staff and resident immunization NR | none |
Rantz, 2012 [74]; Rantz, 2012 [75]; Rantz; 2013 [76] | US, 29 NHs | Quality of care | none | 8 | • Adoption • Perceptions • Sustainment | Some subscales of the Observable Indicators of Quality scale, S | • Rate of Pressure ulcers, S • Other resident outcomes NS |
Seers, 2018 [77]; Rycroft-Malone, 2018 [78] | England, Sweden, Nether-lands, Republic of Ireland, 24 NHs | Urinary incontinence | Facilitating Implemen-tation of Research Evidence | 5 | • Adoption • Reach to residents • Perceptions | Urinary continence treatment S | none |
Tija, 2015 [79] | US, 42 NHs | Use of anti-psychotic medication | none | 4 | • Adoption • Reach to staff • Perceptions | Antipsychotic use NS | none |
Primary study design: Non-randomized and controlled study (includes within group differences in services and resident outcomes) | |||||||
Arling, 2014 [80]; Abrahamson [81] | US, 15 NHs | Falls | none | 5 | • Perceptions | none | Falls rate S |
Azermai, 2017 [82] | Belgium, 2 NHs | Psychotropic medications | Leiehome Project | 2 | • Reach to residents • Sustainment | • Rate of sedative use S • Rate of anti-psychotic use NS | none |
Hanson, 2005 [83] | US, 9 NHs | End of life care | none | 7 | • Adoption • Reach to staff and residents | Rate of hospice enrollment, assessing/treating pain and discussions about end-of-life S | none |
Jones, 2004 [84] | US, 12 NHs | Pain | none | 5 | • Adoption • Perceptions | The rate of pain assessments S | Rate of pain NS |
Kaasalainen, 2012 [41]; Kaasalainen, 2015 [85] | Canada, 4 NHs | Pain | none | 6 | • Reach to residents • Perceptions | Rate of pain assessment tool use and initial pain assessments S | Rate of pain increased overall but less in Intvn. group S |
Olsho, 2014 [86] | US, 25 NHs | Pressure ulcers | none | 7 | • Adoption • Reach to residents | none | Rate of pressure ulcers S |
Rantz, 2018 [35]; Rantz, 2017 [87]; Flesner, 2019 [88]; Popejoy, 2017 [89]; Vogelsmeier, 2015 [90] | US, 16 NHs | Hospital transfers | Missouri Quality Initiative | 9 | • Reach to residents • Perceptions | Rate of antipsychotic use S | • Composite indicator of resident outcomes S • Rate of hospital transfers S |
Rask, 2007 [91] | US, 42 NHs | Falls | none | 7 | • Reach to residents | Rate of documented falls risk assessment and management S | Falls rate was unchanged in Intvn group but increased in control group S |
Sales, 2014 [92]; Sales, 2015 [93] | Canada, 4 NHs | Falls | none | 4 | • Reach to residents • Perceptions | none | Falls rate increased S |
Sheaff, 2018 [38] | England, 23 NHs | Dementia care | Dementia Learning Community | 5 | • Reach to staff and residents • Perceptions | Staff knowledge of dementia NS | Quality of life of residents with dementia NS |
Unroe, 2018 [36] | US, 40 NHs | Hospital transfers | OPTIMISTIC | 8 | • Adoption • Reach to staff | Use of new billing codes for medical care of varied NR | none |
Zimmerman, 2014 [37] | US, 12 NHs | Antibiotic use | none | 7 | • Reach to staff and residents | Rate of prescribing antibiotics decreased overall all but more the Intvn group S | none |
Primary study design: Non-randomized and non-controlled study | |||||||
Abel, 2005 [94] | US, 20 NHs | Pressure ulcers | none | 5 | • Adoption • Reach to residents • Perceptions | Rate of pressure ulcer prevention and treatment S | Rate of pressure ulcers NS |
Badger, 2009 [95] | England, 49 NHs | End of life care | Gold Standards Framework in Care Homes programme | 4 | • Adoption • Reach to residents • Perceptions | Rate of advance care planning S | Rate of NH as the place of death S |
Baier, 2003 [96] | US, 29 NHs | Pressure ulcers | Northeast Pressure Ulcer Project | 8 | • Adoption • Reach to residents • Perceptions | Rate of pressure ulcer prevention and treatment S | none |
Baier, 2004 [97] | US, 17 NHs | Pain | none | 7 | • Adoption • Reach to residents • Perceptions | • Rate of pain assessment and non-pharmacologic pain treatment S • Rate of pharmacologic pain treatment NS | Prevalence of pain S |
Boyle, 2013 [98] | US, 2 NHs | Diabetes care | none | 3 | • Reach to residents • Perceptions | Rate of diabetes care S | Rate of hypoglycemia S |
Bravo, 2005 [99] | Canada, 18 NHs | Quality of care | none | 5 | • Perceptions | Goal Attainment scores NS | none |
Buhr, 2006 [100] | US, 4 NHs | Pain | none | 6 | • Reach to staff | Rate of pain assessments NR | Patient satisfaction with pain care NS |
Carson, 2017 [101] | Canada, 7 NHs | Emergent transfers | London Transfer Project | 7 | • Perceptions | Rate of documenting rationale of emergency department transfers NR | none |
Chodash, 2015 [102] | US, 5 NHs | Depression | Practice Improve-ment Education Project | 6 | • Adoption • Reach to staff and residents | • Knowledge of depression care S • Rate of anti-depressant use S | |
Colon-Emeric, 2006 [103] | US, 36 NHs | Falls | none | 6 | • Adoption • Reach to residents | • Rate of assessing fall risk and prescribing Vitamin D S • Rate of fall risk reduction strategies and prescribing Calcium NS | Falls rate NS |
Dolansky, 2013 [104] | US, 4 NHs | Heart failure | none | 6 | • Reach to residents • Perceptions | Rate of heart failure treatment in one but not all NHs NR | none |
Edwards, 2017 [105] | Australia, 7 NHs | Wound and skin care | Champions for Skin Integrity | 5 | • Perceptions | Rate of wound management and prevention strategies S | The rate of wounds S |
Fallon, 2006 [106] | Australia, 2 NHs | Oral health | none | 6 | • Reach to staff • Perceptions | Staff knowledge of 2 but not all oral health care procedures S | none |
Fine, 2014 [107] | US 8 NHs | Pain | none | 5 | • Reach to staff and residents • Perceptions | • Care plan with pain goals, S • Other processes, NS | none |
Fitzler, 2016 [39] | US, 30 NHs | Dementia care | none | 6 | • Perceptions | Scores on 9 of 10 quality indicators S | Rate of ‘resident-on-staff’ altercations S |
Hartmann, 2018 [40] | US, 6 NHs | Person-centered care | LOCK model | 6 | • Reach to residents • Perceptions | Number of opportunities for staff and resident interactions S | Rate of negative staff and resident interactions NS |
Hickman, 2016 [108]; Ersek, 2018 [109] | US, 19 NHs | Advance care planning | OPTIMISTIC | 8 | • Reach to staff and residents • Perceptions | Rate of advance care planning and changes in written advance care plans NR | none |
US, 11 NHs | Pressure ulcers | Real-Time | 7 | • Reach to residents • Fidelity • Perceptions | Time that certified nursing assistants stayed late to complete documentation S | Rate of high risk residents with pressure ulcers and the rate of new pressure ulcers S | |
Horner, 2005 [112] | US, 9 NHs | Pain | none | 3 | • Adoption | • Rate of pain assessment and non-pharmacologic pain treatment S • Rate of pharmacologic pain treatment NS | none |
Keeney, 2008 [113] | US, 4 NHs | Pain | none | 6 | • Sustainment | • Rate of pain assessment S • Rate of pain treatment NS | none |
Kezerian, 2018 [114] | Canada, 15 NHs | Hospital transfers | Palliative Care in Residential Care Initiative | 5 | • Reach to staff • Perceptions | Rate of 1 of 5 advance care planning services S | Rate of hospital transfers NS |
Kovach, 2008 [115] | US, 8 NHs | Pain | Serial Trial Intervention | 3 | • Reach to staff • Perceptions • Sustainment | Rate of pain assessment and treatment S | Rate of behavioral symptoms NR |
Lai, 2018 [116] | Taiwan, 11 NHs | Hand hygiene | none | 6 | • Reach to residents • Fidelity | none | The patient infection density S |
Lynn, 2007 [117] | US, 35 NHs | Pressure ulcers | 8 | • Adoption | Rate of pressure ulcer risk assessment S | • Rate of Stage III and IV pressure ulcers S • Rate of Stage I and II pressure ulcers NS | |
Ouslander, 2009 [118] | US, 3 NHs | Hospital transfers | INTERACT II | 7 | • Perceptions | none | Rate of hospital transfers NR |
Rask, 2017 [91] | US, 105 NHs | Hospital transfers | INTERACT II | 5 | • Perceptions | none | Hospital transfers in 2 of 3 organizations S |
Rosen, 2005 [119]; Rosen, 2006 [120] | US, 2 NHs | Pressure ulcers | none | 6 | • Reach to staff | none | • Rate of pressure ulcers (Stage II or greater) S • Rate of pressure ulcers equivalent for Black and White residents, S |
Sand, 2007 | US, 15 NHs | Staff immunization | none | 5 | • Adoption • Perceptions | Rate of immunization, NS | none |
Scott-Cawiezell, 2009 [121] | US, 5 NHs | Nursing care | none | 5 | • Reach to residents • Perceptions | Monitoring implementation of an electronic medical records system NR | none |
Simmons, 2013 [122] | US, 2 NHs | Weight loss | none | 9 | • Reach to staff and residents • Perceptions | Quantity of food consumed and the rate staff offered alternative meal choices S | Daily weight loss NS |
Tena-Nelson, 2012 [123] | US, 18 NHs | Hospital transfers | INTERACT | 5 | • Adoption • Reach to staff and residents • Perceptions | Rate staff used tools for monitoring and communicating changes in health NR | Rate of hospital transfers NS |
Torma, 2014 [124] | Sweden, 4 NHs | Nutrition | none | 6 | • NR | none | Nutritional status scores NS |
Triller, 2014 [125] | US, 12 NHs | Anti-coagulant therapy | none | 7 | • Adoption • Perceptions | Rate of timely post-antibiotic prescribing international normalised testing S | none |
Wilson, 2018 [126] | England 2 NHs | Hydration | none | 3 | • Perceptions | Rate fluids offered NR | Rate of adverse health events NR |
Zubkoff, 2018 [127] | US, 21 NHs | Falls | none | 7 | • Perceptions | Rate of “post-fall’ huddles NR | Falls rate NS |