Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators (IQUARE)
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
- Functional decline rate
- Drug prescriptions (quantity and quality)
- Prevalence of adverse health outcomes (e.g., falls)
- Planning and implementation of therapeutic measures
|Quality Indicators Physical Disability||Behavioral: Audit and Feedback Behavioral: Cooperative Work|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Health Services Research
|Official Title:||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.|
- Change from baseline in nursing home quality indicators at 18 months [ Time Frame: baseline and 18-month follow-up ]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).
- Onset of dependence in activities of daily living from baseline to 18 months follow-up [ Time Frame: baseline and 18-month 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".
- Reduction in the prescription of psychotropic drugs from baseline to 18-month follow-up [ Time Frame: baseline and 18-month follow-up ]It will be examined if the rate of antidepressants, anxiolytics, antipsychotics, and hypnotics/sedatives (coded according to the Anatomical Therapeutic Chemical classification. Information available at: http://www.whocc.no/atc_ddd_index/) prescriptions will be reduced between baseline and follow-up. A particular attention will be given to the prevalence of people taking 3 or more psychotropics (increased risk of drug-drug interaction and adverse drug reaction) and to the use of these medications among people with dementia.
|Study Start Date:||May 2011|
|Study Completion Date:||March 2013|
|Primary Completion Date:||July 2011 (Final data collection date for primary outcome measure)|
Experimental: strong intervention group (SIG)
Nursing homes that received audit and feedback information on quality indicators and benefited of cooperative work meetings with hospital geriatricians
Behavioral: Audit and Feedback
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.Behavioral: Cooperative Work
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.
Active Comparator: intervention group (LIG)
Nursing homes that only received audit and feedback information on quality indicators
Behavioral: Audit and Feedback
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.
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01703689
Show 175 Study Locations
|Principal Investigator:||Yves Rolland, MD, PhD||La Grave- Casselardit University Hospital Centre, Service de Médecine Interne et Gérontologie Clinique - Gérontopôle|