title: Do structural quality indicators of nutritional care influence malnutrition prevalence in Dutch, German, and Austrian nursing homes?
abstract: OBJECTIVE
  The aim of this study was to explore whether structural quality indicators for nutritional care influence malnutrition prevalence in the Netherlands, Germany, and Austria. Furthermore, differences in malnutrition prevalence and structural quality indicators for nutritional care nursing homes in the three countries were examined.
  
  
  METHODS
  This was a cross-sectional, multicenter study using a standardized questionnaire at the patient, ward, and institutional levels. Malnutrition was assessed by low body mass index, undesired weight loss, and reduced intake. Structural quality indicators of nutritional care were measured at the ward and institutional levels.
  
  
  RESULTS
  The prevalence of malnutrition differed significantly between the three countries (Netherlands 18%, Germany 20%, and Austria 22.7%). Structural quality indicators related to nutritional care as having a guideline of prevention and treatment of malnutrition were related to malnutrition and explained malnutrition prevalence variance between the Netherlands and Germany. Differences between the Netherlands and Austria in malnutrition prevalence still existed after controlling for these quality structural indicators.
  
  
  CONCLUSIONS
  Structural quality indicators of nutritional care are important in explaining malnutrition variance between the Netherlands and Germany. However, they did not explain the difference in malnutrition prevalence between the Netherlands and Austria. Investigating the role of process indicators may provide insight in the role of structural quality indicators of nutritional care in explaining the malnutrition prevalence differences between the Netherlands and Austria.
authors.affiliation: Caphri, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Electronic address: n.vannie@maastrichtuniversity.nl.
authors.forename: Noémi C
authors.initials: NC
authors.lastname: van Nie
authors.affiliation: Caphri, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Judith M M
authors.initials: JM
authors.lastname: Meijers
authors.affiliation: Caphri, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Caphri, Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.affiliation: Institute of Nursing Science, Medical University Graz, Graz, Austria.
authors.forename: Christa
authors.initials: C
authors.lastname: Lohrmann
authors.affiliation: Caphri, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Spreeuwenberg
authors.affiliation: Caphri, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Ruud J G
authors.initials: RJ
authors.lastname: Halfens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged; D006801:Humans; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control*; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D015596:Nutrition Assessment; D015995:Prevalence; D019984:Quality Indicators, Health Care
keywords: Countries; Malnutrition; Nursing homes; Structural quality indicators