Quality Indicators for Residential Long-Term Care for the Elderly: A Scoping Review
https://doi.org/10.17583/rasp.13874
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The objective of this study was to review the existing literature on the evaluation of care in residential homes for elderly, considering its quality through quality indicators, using secondary databases. A systematic search was conducted, following the PRISMA guidelines for scoping reviews. One hundred and ten studies were included, in which 1,239 indicators were identified. More than half of the identified indicators (N=663, 53%) were linked to outcomes, with about 33% (N=413) related to structure, and 14% (N=175) to process indicators. The most frequently studied indicators as dependent variables were: "Pressure ulcer," "Staffing issues," and "Psychotropic Drug Use." As independent variables, indicators relating to structure were prominent: "Facility characteristics," "Resident characteristics," and "Staffing Issues”. There is a broad consensus around a care approach centered on clinical and structural aspects, in accordance with the profile of residents, and reflecting historical concerns about quality of care and patient safety that were the origin of quality assessment systems, and which remain the focus of concerns to this day.
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Anthony, D., Alosoumi, D., & Safari, R. (2019). Prevalence of pressure ulcers in long-term care: a global review. Journal of Wound Care, 28(11), 702-709. https://dx.doi.org/10.12968/jowc.2019.28.11.702
Google Scholar CrossrefArmijo-Olivo, S., Craig, R., Corabian, P., Guo, B., Souri, S., & Tjosvold, L. (2020). Nursing staff time and care quality in long-term care facilities: a systematic review. The Gerontologist, 60(3), e200-e217. https://dx.doi.org/10.1093/geront/gnz053
Google Scholar CrossrefBelmin, J., Georges, S., Franke, F., Daniau, C., Cochet, A., Durand, C., Noury, U., do Espirito Santo, M. E. G., Fonteneau, L., & Pariel, S. (2021). Coronavirus disease 2019 in French residential care facilities: A nationwide study. Journal of the American Medical Directors Association, 22(6), 1142-1145. https://dx.doi.org/10.1016/j.jamda.2021.03.013
Google Scholar CrossrefBerlowitz, D. R., Bezerra, H. Q., Brandeis, G. H., Kader, B., & Anderson, J. J. (2000). Are we improving the quality of nursing home care: The case of pressure ulcers. Journal of the American Geriatrics Society, 48(1), 59-62. https://dx.doi.org/10.1111/j.1532-5415.2000.tb03029.x
Google Scholar CrossrefBernabei, R., Gambassi, G., Lapane, K., Sgadari, A., Landi, F., Gatsonis, C., Lipsitz, L., & Mor, V. (1999). Characteristics of the SAGE database: A new resource for research on outcomes in long-term care. Journals of Gerontology - Series A, 54(1), M25-M33. https://dx.doi.org/10.1093/gerona/54.1.M25
Google Scholar CrossrefBowblis, J. R., & Applebaum, R. (2017). How does Medicaid reimbursement impact nursing home quality? The effects of small anticipatory changes. Health Services Research, 52(5), 1729-1748. https://dx.doi.org/10.1111/1475-6773.12553
Google Scholar CrossrefBowblis, J. R., Crystal, S., Intrator, O., & Lucas, J. A. (2012). Response to regulatory stringency: The case of antipsychotic medication use in nursing homes. Health Economics, 21(8), 977-993. https://dx.doi.org/10.1002/hec.1775
Google Scholar CrossrefBurgess, J. F., Jr., Shwartz, M., Stolzmann, K., & Sullivan, J. L. (2018). The relationship between costs and quality in veterans health administration community living centers: an analysis using longitudinal data. Health Services Research, 53(5), 3881-3897. https://dx.doi.org/10.1111/1475-6773.12975
Google Scholar CrossrefCastle, N., Engberg, J., & Men, A. (2018). Satisfaction of discharged nursing home residents. Journal of Applied Gerontology, 37(10), 1225-1243. https://dx.doi.org/10.1177/0733464816656095
Google Scholar CrossrefCastle, N. G., & Ferguson, J. C. (2010). What is nursing home quality and how is it measured? The Gerontologist, 50(4), 426-442. https://dx.doi.org/10.1093/geront/gnq052
Google Scholar CrossrefChadborn, N. H., Devi, R., Hinsliff-Smith, K., Banerjee, J., & Gordon, A. L. (2021). Quality improvement in long-term care settings: A scoping review of effective strategies used in care homes. European Geriatric Medicine, 12(1), 17-26. https://dx.doi.org/10.1007/s41999-020-00389-w
Google Scholar CrossrefChang, S. C., Shiu, M. N., Chen, H. T., Ng, Y. Y., Lin, L. C., & Wu, S. C. (2015). Evaluation of care quality for disabled older patients living at home and in institutions. Journal of Clinical Nursing, 24(23-24), 3469-3480. https://dx.doi.org/10.1111/jocn.12946
Google Scholar CrossrefChen, A. T., Ryskina, K. L., & Jung, H.-Y. (2020). Long-term care, residential facilities, and COVID-19: an overview of federal and state policy responses. Journal of the American Medical Directors Association, 21(9), 1186-1190. https://dx.doi.org/10.1016/j.jamda.2020.07.001
Google Scholar CrossrefChen, M. M., & Grabowski, D. C. (2015). Intended and unintended consequences of minimum staffing standards for nursing homes. Health Economics, 24(7), 822-839. https://dx.doi.org/10.1002/hec.3063
Google Scholar CrossrefClemens, S., Wodchis, W., McGilton, K., McGrail, K., & McMahon, M. (2021). The relationship between quality and staffing in long-term care: A systematic review of the literature 2008-2020. International Journal of Nursing Studies, 122, Article 104036. https://dx.doi.org/10.1016/j.ijnurstu.2021.104036
Google Scholar CrossrefDonabedian, A. (1988). The quality of care: how can it be assessed? JAMA, 260(12), 1743-1748. https://dx.doi.org/10.1001/jama.1988.03410120089033
Google Scholar CrossrefEstabrooks, C. A., Knopp-Sihota, J. A., & Norton, P. G. (2013). Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data. BMC Research Notes, 6, Article 460. https://dx.doi.org/10.1186/1756-0500-6-460
Google Scholar CrossrefFry, L., Fry, L., Philip, A., Mackenzie, T., Ahe, L., Doan, E., & Ahmed, F. (2018). High acuity unit in SNF: Novel program to improve quality of care for post-acute patients. Journal of the American Medical Directors Association, 19, Article PB18. https://dx.doi.org/10.1016/j.jamda.2017.12.058
Google Scholar CrossrefGori, C., Fernandez, J.-L., & Wittenberg, R. (2015). Long-term care reforms in OECD countries. Policy Press. https://dx.doi.org/10.1332/policypress/9781447305057.001.0001
Google Scholar CrossrefGray, C., & Farrah, K. (2019). Homelike models in long term care: A review of clinical effectiveness, cost-effectiveness, and guidelines. Canadian Agency for Drugs and Technologies in Health.
Google Scholar CrossrefHawes, C., Mor, V., Phillips, C. D., Fries, B. E., Morris, J. N., Steele-Friedlob, E., . . . Nennstiel, M. (1997). The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality. J Am Geriatr Soc, 45(8), 977-985. doi:10.1111/j.1532-5415.1997.tb02970.x
Google Scholar CrossrefHjaltadottir, I., Ekwall, A. K., Nyberg, P., & Hallberg, I. R. (2012). Quality of care in Icelandic nursing homes measured with Minimum Data Set quality indicators: Retrospective analysis of nursing home data over 7 years. International Journal of Nursing Studies, 49(11), 1342-1353. https://dx.doi.org/10.1016/j.ijnurstu.2012.06.004
Google Scholar CrossrefHjelmar, U., Bhatti, Y., Petersen, O. H., Rostgaard, T., & Vrangbæk, K. (2018). Public/private ownership and quality of care: Evidence from Danish nursing homes. Social Science and Medicine, 216, 41-49. https://dx.doi.org/10.1016/j.socscimed.2018.09.029
Google Scholar CrossrefHutchinson, A. M., Milke, D. L., Maisey, S., Johnson, C., Squires, J. E., Teare, G., & Estabrooks, C. A. (2010). The resident assessment instrument-minimum data set 2.0 quality indicators: a systematic review. BMC Health Services Research, 10(1), Article 166. https://dx.doi.org/10.1186/1472-6963-10-166
Google Scholar CrossrefHyer, K., Thomas, K. S., Johnson, C. E., Harman, J. S., & Weech-Maldonado, R. (2013). Do Medicaid Incentive Payments Boost Quality? Florida's Direct Care Staffing Adjustment Program. Journal of Aging & Social Policy, 25(1), 65-82. https://dx.doi.org/10.1080/08959420.2012.705629
Google Scholar CrossrefJensdóttir, A. B., Rantz, M., Hjaltadóttir, I., Gudmundsdòttir, H., Rook, M., & Grando, V. (2003). International comparison of quality indicators in United States, Icelandic and Canadian nursing facilities. International Nursing Review, 50(2), 79-84. https://dx.doi.org/10.1046/j.1466-7657.2003.00163.x
Google Scholar CrossrefJeon, Y. H., Casey, A. N., Vo, K., Rogers, K., Poole, B., & Fethney, J. (2019). Associations between clinical indicators of quality and aged-care residents' needs and consumer and staff satisfaction: the first Australian study. Australian Health Review, 43(2), 133-141. https://dx.doi.org/10.1071/ah17213
Google Scholar CrossrefJoling, K. J., Van Eenoo, L., Vetrano, D. L., Smaardijk, V. R., Declercq, A., Onder, G., Van Hout, H. P., & van der Roest, H. G. (2018). Quality indicators for community care for older people: A systematic review. PLoS One, 13(1), Article e0190298. https://dx.doi.org/10.1371/journal.pone.0190298
Google Scholar CrossrefJorgensen, M., Siette, J., Georgiou, A., & Westbrook, J. I. (2018). Longitudinal variation in pressure injury incidence among long-term aged care facilities. International Journal for Quality in Health Care, 30(9), 684-691. https://dx.doi.org/10.1093/intqhc/mzy087
Google Scholar CrossrefJosefsson, M. S., Nydahl, M., Persson, I., & Sydner, Y. M. (2017). Quality indicators of nutritional care practice in elderly care. Journal of Nutrition Health & Aging, 21(9), 1057-1064. https://dx.doi.org/10.1007/s12603-017-0970-8
Google Scholar CrossrefKang-Yi, C. D., Mandell, D. S., Mui, A. C., & Castle, N. G. (2011). Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents. Health Care Management Review, 36(1), 47-57. https://dx.doi.org/10.1097/HMR.0b013e3181f8a864
Google Scholar CrossrefKohler, P. O., & Wunderlich, G. S. (2001). Improving the quality of long-term care. National Academic Press.
Google Scholar CrossrefLaine, J., Linna, M., Noro, A., & Häkkinen, U. (2005). The cost efficiency and clinical quality of institutional long-term care for the elderly. Health Care Management Science, 8(2), 149-156. https://dx.doi.org/10.1007/s10729-005-0397-3
Google Scholar CrossrefLehning, A. J., & Austin, M. J. (2010). Long-term care in the United States: Policy themes and promising practices. Journal of Gerontological Social Work, 53(1), 43-63. https://dx.doi.org/10.1080/01634370903361979
Google Scholar CrossrefLi, Y., Li, Q., & Tang, Y. (2016). Associations between family ratings on experience with care and clinical quality-of-care measures for nursing home residents. Medical Care Research and Review, 73(1), 62-84. https://dx.doi.org/10.1177/1077558715596470
Google Scholar CrossrefMant, J. (2001). Process versus outcome indicators in the assessment of quality of health care. International Journal for Quality in Health Care, 13(6), 475-480. https://dx.doi.org/10.1093/intqhc/13.6.475
Google Scholar CrossrefMor, V. (2006). Defining and measuring quality outcomes in long-term care. Journal of the American Medical Directors Association, 7(8), 532-540. https://dx.doi.org/10.1016/j.jamda.2006.08.001
Google Scholar CrossrefMukamel, D. B., Watson, N. M., Meng, H., & Spector, W. D. (2003). Development of a risk-adjusted urinary incontinence outcome measure of quality for nursing homes Medical Care, 41(4), 467-478. https://dx.doi.org/10.1097/01.MLR.0000053227.95476.02
Google Scholar CrossrefNakrem, S., Vinsnes, A. G., Harkless, G. E., Paulsen, B., & Seim, A. (2009). Nursing sensitive quality indicators for nursing home care: international review of literature, policy and practice. International Journal of Nursing Studies, 46(6), 848-857. https://dx.doi.org/10.1016/j.ijnurstu.2008.11.005
Google Scholar CrossrefNational Academies of Sciences, Health and Medicine Division, Board on Health Care Services and Committee on the Quality of Care in Nursing Homes (2022). The national imperative to improve nursing home quality: honoring our commitment to residents, families, and staff. The National Academies Press. https://dx.doi.org/doi:10.17226/26526
Google Scholar CrossrefOECD (2021). Health at a Glance 2021. OECD Indicators. OECD Publishing. https://dx.doi.org/10.1787/ae3016b9-en
Google Scholar CrossrefOECD, & European Union (2013). A Good Life in Old Age? Monitoring and Improving Quality in Long-term Care. OECD Publishing. https://dx.doi.org/10.1787/9789264194564-en
Google Scholar CrossrefOlivia, J., & Longobardo, L. M. P. (2022). Impacto de la COVID-19 en la atención sociosanitaria: el caso de las residencias. Informe SESPAS 2022. Gaceta Sanitaria, 36, S56-S60. https://dx.doi.org/10.1016/j.gaceta.2022.02.003
Google Scholar CrossrefOsińska, M., Favez, L., & Zúñiga, F. (2022). Evidence for publicly reported quality indicators in residential long-term care: a systematic review. BMC Health Services Research, 22(1), 1408. https://dx.doi.org/10.1186/s12913-022-08804-7
Google Scholar CrossrefPhillips, C. D., Zimmerman, D., Bernabei, R., & Jonsson, P. V. (1997). Using the Resident Assessment Instrument for quality enhancement in nursing homes. Age Ageing, 26(Suppl 2), 77-81. https://dx.doi.org/10.1093/ageing/26.suppl_2.77
Google Scholar CrossrefReichert, A. R., & Stroka, M. A. (2018). Nursing home prices and quality of care—Evidence from administrative data. Health Economics, 27(1), 129-140. https://dx.doi.org/10.1002/hec.3518
Google Scholar CrossrefRobins, L. M., Lee, D. A., Bell, J. S., Srikanth, V., Möhler, R., Hill, K. D., & Haines, T. P. (2021). Definition and measurement of physical and chemical restraint in long-term care: A systematic review. International Journal of Environmental Research and Public Health, 18(7), Article 3639. https://dx.doi.org/10.3390/ijerph18073639
Google Scholar CrossrefShin, J. H., & Hyun, T. K. (2015). Nurse staffing and quality of care of nursing home residents in Korea. Journal of Nursing Scholarship, 47(6), 555-564. https://dx.doi.org/10.1111/jnu.12166
Google Scholar CrossrefSteel, K., Ljunggren, G., Topinková, E., Morris, J. N., Vitale, C., Parzuchowski, J., Nonemaker, S., Frijters, D. H., Rabinowitz, T., Murphy, K. M., Ribbe, M. W., & Fries, B. E. (2003). The RAI-PC: an assessment instrument for palliative care in all settings. American Journal of Hospice and Palliative Medicine, 20(3), 211-219. https://dx.doi.org/10.1177/104990910302000311
Google Scholar CrossrefTricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D., Horsley, T., & Weeks, L. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine, 169(7), 467-473. https://dx.doi.org/10.7326/M18-0850
Google Scholar CrossrefWei, Y. J., Simoni-Wastila, L., Zuckerman, I. H., Huang, T. Y. J., Brandt, N., Moyo, P., & Lucas, J. A. (2014). Quality of psychopharmacological medication prescribing and mortality in Medicare beneficiaries in nursing homes. Journal of the American Geriatrics Society, 62(8), 1490-1504. https://dx.doi.org/10.1111/jgs.12939
Google Scholar CrossrefWerner, R. M., Konetzka, R. T., & Polsky, D. (2013). The effect of pay-for-performance in nursing homes: Evidence from state Medicaid programs. Health Services Research, 48(4), 1393-1414. https://dx.doi.org/10.1111/1475-6773.12035
Google Scholar CrossrefWilliams, A., Straker, J. K., & Applebaum, R. (2016). The nursing home five star rating: How does it compare to resident and family views of care? The Gerontologist, 56(2), 234-242. https://dx.doi.org/10.1093/geront/gnu043
Google Scholar CrossrefWinblad, U., Blomqvist, P., & Karlsson, A. (2017). Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden. BMC Health Services Research, 17, Article 487. https://dx.doi.org/10.1186/s12913-017-2403-0
Google Scholar CrossrefZimmerman, D. R. (2003). Improving nursing home quality of care through outcomes data: the MDS quality indicators. International Journal of Geriatric Psychiatry, 18(3), 250-257. https://dx.doi.org/10.1002/gps.820
Google Scholar CrossrefZimmerman, D. R., Karon, S. L., Arling, G., Clark, B. R., Collins, T., Ross, R., & Sainfort, F. (1995). Development and testing of nursing home quality indicators. Health Care Financing Review, 16(4), 107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193525/
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