Table 1.
Characteristics of included studies
| Study, nationality and design | Participating providers (Level of training) | Participating residents (Clusters, number) | Outcome (relevant for this systematic review) | Outcome measurement | Outcome measurement frequency/period | Length of post-intervention follow-up |
|---|---|---|---|---|---|---|
| De Visschere et al. (2012) [31], Belgium. Cluster-randomised controlled trial. |
Nurses, nurse aids. Level of training not stated. | 12 nursing homes (N = 297). Nursing home residents, mean age 84 years, high degree of physical disability and cognitive impairment. |
Patient outcome: oral hygiene level of the participating residents: dental plaque, denture plaque, tongue plaque (primary outcomes). | Dental plaque: Silnes and Löe plaque index. Denture plaque: Augsburger and Elahi Methylene-blue test. Tongue plaque: Winkel tongue coating index. Tests carried out by trained external examiners. | Measured once after the 6 months intervention period. | - |
| Köpke et al. (2012) [32], Germany. Cluster-randomised controlled trial. |
Nurses with three years of vocational training, certified nurse assistants with 1 year vocational training, untrained nurse assistants. | 36 nursing homes (N = 3670). Nursing home residents, mean age 85.5 years, high degree of physical disability and cognitive impairment. |
Professional practice: the number of residents with physical restraints after 6 months (primary outcome). Restraint use at 3 months (secondary outcome). | Unannounced observation by blinded investigators on three different occasions during one day. | Measured after 3 and 6 months during the 6 months intervention period. | - |
| Tjia et al. (2015) [36], USA. Cluster-randomised controlled trial. |
Nurses, certified nurse assistants, physicians, nursing home leaders. Level of training not stated. | 42 nursing homes (N = unknown). |
Professional practice: Facility-level change in atypical antipsychotic prescribing rates (primary outcome). |
Screening of pharmacy dispensing data. Not stated who assessed the data. | Measured monthly during the 12 months intervention period. | - |
| Van Gaal (2011a/b) [33, 34], Netherlands. Cluster-randomised controlled trial. |
Nurses. Level of training not stated. | 10 wards from 6 nursing homes (N = 392). Nursing home residents, mean age 78 years, half of them physically impaired. No cognitive impairment. |
Patient outcome (Part I): Incidence of adverse events: pressure ulcer, urinary tract infections and falls (primary outcome). Professional practice (Part II): adequate care given to nursing home residents at risk of adverse events (secondary outcome). |
Primary outcome: chart review and inspection of patient’s skin by independent research assistants. Secondary outcome: chart review and patient observation by independent research assistants. |
Primary outcomes: measured weekly during post-intervention follow up. Secondary outcomes: measured weekly during post-intervention follow-up. Three additional observational visits on every ward. No measurement during the 14 months intervention period. |
9 months. |
| Ward et al. (2010) [35], Australia. Cluster-randomised controlled trial. |
Nursing home staff including physicians. Level of training not stated. | 88 nursing homes (N = 5391). Nursing home residents, mean age 85.5 years, about 70 % able to stand or walk with or without assistance, 21 % received dementia-specific care. |
Professional practice: use of vitamin D supplements, use of hip protectors (primary outcomes). Patient outcome: change in fall rates, residents with a fractured neck of femur (primary outcomes). |
Chart review by nursing home staff. | Monthly during the 17 months intervention period. | - |