Improving the Quality of Care of Long‐Stay Nursing Home Residents in France

Abstract

The aim of the Impact d'une démarche QUA lité sur l’évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes ( IQUARE ) study was to examine the effects of a global intervention comprising professional support and education for nursing home ( NH ) staff on quality indicators ( QI s) and functional decline and emergency department ( ED ) transfers of residents. One hundred seventy‐five NH s in France (a total of 6,275 residents randomly selected from NH s) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18‐month follow‐up. NH s were allocated to a quality audit and feedback intervention (control group: 90 NH s, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NH s, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QI s were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large‐scale efforts to improve QI s involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NH s.