title: Improving the Quality of Care of Long-Stay Nursing Home Residents in France.
abstract: The aim of the Impact d'une démarche QUAlité 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 (QIs) and functional decline and emergency department (ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 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 NHs, 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 QIs 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 QIs 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 NHs.
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.|Unité Mixe de Recherche, Institut National de la Santé et de la Recherche Médicale 1027, University of Toulouse III, Toulouse, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
authors.affiliation: Observatoire Régional de la Santé de Midi-Pyrénées, Toulouse, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: Agence Régionale de la Santé-Midi Pyrénées, Toulouse, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Piau
authors.affiliation: Observatoire Régional de la Santé de Midi-Pyrénées, Toulouse, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Cayla
authors.affiliation: Agence Régionale de la Santé-Midi Pyrénées, Toulouse, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bouget
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.|Unité Mixe de Recherche, Institut National de la Santé et de la Recherche Médicale 1027, University of Toulouse III, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.|Unité Mixe de Recherche, Institut National de la Santé et de la Recherche Médicale 1027, University of Toulouse III, Toulouse, France.
authors.forename: Philipe
authors.initials: P
authors.lastname: de Souto Barreto
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000592:standards; D008297:Male; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods / Q000592:standards; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D013192:Staff Development / Q000379:methods / Q000592:standards
keywords: disability; emergency; nursing homes; quality indicators; transfer