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Quality improvement studies in nursing homes: a scoping review
Mark Toles1, Cathleen Colón-Emeric2, Elizabeth Moreton3
1University of North Carolina at Chapel Hill, Chapel Hill, USA. mtoles@email.unc.edu.
BMC Health Services Research
|August 13, 2021
Summary
This scoping review maps quality improvement (QI) strategies in nursing homes (NHs). Findings reveal varied strategy use and outcome reporting, offering guidance for future QI research and practice.
Area of Science:
- Healthcare Management
- Implementation Science
- Gerontology
Background:
- Quality Improvement (QI) is crucial for enhancing patient outcomes in nursing homes (NHs).
- Understanding the application of QI strategies in NHs is limited, hindering the replication of successful interventions.
- This study addresses this gap by examining the use, evaluation, and reporting of QI strategies within NH settings.
Purpose of the Study:
- To conduct a scoping review of published literature on Quality Improvement (QI) in nursing homes (NHs).
- To map the utilization, assessment, and dissemination of QI strategies and their outcomes in NHs.
- To identify barriers and facilitators for effective QI implementation in long-term care.
Main Methods:
- A comprehensive scoping review of articles published from July 2003 to February 2019.
- Inclusion criteria required "quality improvement" terminology, QI models/strategies, impact on service/resident outcomes, and studies involving two or more NHs.
- Data extraction focused on study design, QI strategies, and implementation, service, and resident outcomes, followed by narrative synthesis.
Main Results:
- 77 articles reporting on 59 studies were included, focusing on issues like pressure ulcers, falls, and pain.
- Studies employed an average of 6-7 QI strategies, with significant variation in their application (e.g., in-person training at 55% vs. plan-do-study-act cycles at 20%).
- Implementation outcomes were assessed inconsistently, with staff perceptions reported more frequently than fidelity or sustainment. Service outcomes improved more often than resident outcomes in statistically tested studies.
Conclusions:
- This review provides a comprehensive overview of published QI research in NHs.
- Findings offer preliminary guidance for designing future studies to enhance the replication and synthesis of effective QI solutions.
- The results suggest avenues for refining procedures to improve the efficacy of QI initiatives in NHs.
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