Table 2.
Study Characteristics (N = 59 studies)
| Papers | Setting | Problem | Project or Study Name | QI Strategies (count) | Implementation Outcomes (type) | Outcomes S = p < .05, NS = p ≥ .05, NR = S not reported |
|
|---|---|---|---|---|---|---|---|
| Service | Resident | ||||||
| Primary study design: Cluster randomized and controlled trial (includes between group differences in service and resident outcomes) | |||||||
| Boyd, 2014 [61] |
New Zealand, 29 NHsa |
Hospital transfers |
Residential Aged Care Integration Program | 5 |
• Adoption • Reach to staff |
none | Falls rate increased overall but less in Intvn.b group S |
| Bravo, 2005 [62] |
Canada, 40 NHs |
Quality of care | none | 6 | • Adoption | Quality of care scores NS | none |
| Colon-Emeric, 2007 [63] |
US, 67 NHs |
Falls and fractures | none | 4 |
• Adoption • Reach to residents |
Use of hip protectors and pharmacotherapy NS | Falls rate NS |
| Colon-Emeric, 2013 [64] |
US, 8 NHs |
Falls | CONNECT for Quality | 9 |
• Reach to staff • Reach to residents |
• Communication and safety culture scores S • Falls risk reduction activities NS |
none |
| Colon-Emeric, 2017 [65]; Colon-Emeric, 2016 [56] |
US, 24 NHs |
Falls | CONNECT for Quality | 9 |
• Reach to staff and residents • Sustainment |
Falls risk reduction activities NS | Falls rate NS |
| Crespy, 2016 [66] |
US, 37 NHs |
Symptoms of depression | Promoting Positive Well-Being | 5 |
• Adoption • Reach to staff • Perceptions |
none | Rate of symptoms of depression S |
|
Kane, 2017 [67]; Huckfedlt, 2018 [68]; Tappen, 2018 [69]; Tappen, 2017 [70] |
US,85 NHs |
Hospital transfers |
INTERACT | 8 |
• Adoption • Reach to residents • Perceptions |
Rate staff used tools for monitoring and communicating changes in health NR |
• Hospital transfers NS • In NHs with high tool use, hospital transfers S |
|
Kennedy, 2015 [71]; Kennedy, 2014 [72] |
Canada, 12 NHs | Osteo-porosis and fractures | Vitamin D and Osteo-porosis Study | 8 |
• Adoption • Reach to staff and residents |
• Vitamin D and Calcium prescribing S • Osteoporosis medication prescribing NS |
none |
| Nace, 2011 [73] | US, 6 NHs | Immuni-zation | none | 5 | • Reach to residents | Staff and resident immunization NR | none |
|
Rantz, 2012 [74]; Rantz, 2012 [75]; Rantz; 2013 [76] |
US, 29 NHs | Quality of care | none | 8 |
• Adoption • Perceptions • Sustainment |
Some subscales of the Observable Indicators of Quality scale, S |
• Rate of Pressure ulcers, S • Other resident outcomes NS |
|
Seers, 2018 [77]; Rycroft-Malone, 2018 [78] |
England, Sweden, Nether-lands, Republic of Ireland, 24 NHs | Urinary incontinence | Facilitating Implemen-tation of Research Evidence | 5 |
• Adoption • Reach to residents • Perceptions |
Urinary continence treatment S | none |
| Tija, 2015 [79] | US, 42 NHs | Use of anti-psychotic medication | none | 4 |
• Adoption • Reach to staff • Perceptions |
Antipsychotic use NS | none |
| Primary study design: Non-randomized and controlled study (includes within group differences in services and resident outcomes) | |||||||
|
Arling, 2014 [80]; Abrahamson [81] |
US, 15 NHs | Falls | none | 5 | • Perceptions | none | Falls rate S |
| Azermai, 2017 [82] | Belgium, 2 NHs | Psychotropic medications | Leiehome Project | 2 |
• Reach to residents • Sustainment |
• Rate of sedative use S • Rate of anti-psychotic use NS |
none |
| Hanson, 2005 [83] | US, 9 NHs | End of life care | none | 7 |
• Adoption • Reach to staff and residents |
Rate of hospice enrollment, assessing/treating pain and discussions about end-of-life S | none |
| Jones, 2004 [84] | US, 12 NHs | Pain | none | 5 |
• Adoption • Perceptions |
The rate of pain assessments S | Rate of pain NS |
|
Kaasalainen, 2012 [41]; Kaasalainen, 2015 [85] |
Canada, 4 NHs | Pain | none | 6 |
• Reach to residents • Perceptions |
Rate of pain assessment tool use and initial pain assessments S | Rate of pain increased overall but less in Intvn. group S |
| Olsho, 2014 [86] | US, 25 NHs | Pressure ulcers | none | 7 |
• Adoption • Reach to residents |
none | Rate of pressure ulcers S |
|
Rantz, 2018 [35]; Rantz, 2017 [87]; Flesner, 2019 [88]; Popejoy, 2017 [89]; Vogelsmeier, 2015 [90] |
US, 16 NHs | Hospital transfers | Missouri Quality Initiative | 9 |
• Reach to residents • Perceptions |
Rate of antipsychotic use S |
• Composite indicator of resident outcomes S • Rate of hospital transfers S |
| Rask, 2007 [91] | US, 42 NHs | Falls | none | 7 | • Reach to residents | Rate of documented falls risk assessment and management S | Falls rate was unchanged in Intvn group but increased in control group S |
|
Sales, 2014 [92]; Sales, 2015 [93] |
Canada, 4 NHs | Falls | none | 4 |
• Reach to residents • Perceptions |
none | Falls rate increased S |
| Sheaff, 2018 [38] | England, 23 NHs | Dementia care | Dementia Learning Community | 5 |
• Reach to staff and residents • Perceptions |
Staff knowledge of dementia NS | Quality of life of residents with dementia NS |
| Unroe, 2018 [36] | US, 40 NHs | Hospital transfers | OPTIMISTIC | 8 |
• Adoption • Reach to staff |
Use of new billing codes for medical care of varied NR | none |
| Zimmerman, 2014 [37] | US, 12 NHs | Antibiotic use | none | 7 | • Reach to staff and residents | Rate of prescribing antibiotics decreased overall all but more the Intvn group S | none |
| Primary study design: Non-randomized and non-controlled study | |||||||
| Abel, 2005 [94] | US, 20 NHs | Pressure ulcers | none | 5 |
• Adoption • Reach to residents • Perceptions |
Rate of pressure ulcer prevention and treatment S | Rate of pressure ulcers NS |
| Badger, 2009 [95] | England, 49 NHs | End of life care | Gold Standards Framework in Care Homes programme | 4 |
• Adoption • Reach to residents • Perceptions |
Rate of advance care planning S | Rate of NH as the place of death S |
| Baier, 2003 [96] | US, 29 NHs | Pressure ulcers | Northeast Pressure Ulcer Project | 8 |
• Adoption • Reach to residents • Perceptions |
Rate of pressure ulcer prevention and treatment S | none |
| Baier, 2004 [97] | US, 17 NHs | Pain | none | 7 |
• Adoption • Reach to residents • Perceptions |
• Rate of pain assessment and non-pharmacologic pain treatment S • Rate of pharmacologic pain treatment NS |
Prevalence of pain S |
| Boyle, 2013 [98] |
US, 2 NHs |
Diabetes care | none | 3 |
• Reach to residents • Perceptions |
Rate of diabetes care S | Rate of hypoglycemia S |
| Bravo, 2005 [99] |
Canada, 18 NHs |
Quality of care | none | 5 | • Perceptions | Goal Attainment scores NS | none |
| Buhr, 2006 [100] |
US, 4 NHs |
Pain | none | 6 | • Reach to staff | Rate of pain assessments NR | Patient satisfaction with pain care NS |
| Carson, 2017 [101] | Canada, 7 NHs | Emergent transfers | London Transfer Project | 7 | • Perceptions | Rate of documenting rationale of emergency department transfers NR | none |
| Chodash, 2015 [102] | US, 5 NHs | Depression | Practice Improve-ment Education Project | 6 |
• Adoption • Reach to staff and residents |
• Knowledge of depression care S • Rate of anti-depressant use S |
|
| Colon-Emeric, 2006 [103] | US, 36 NHs | Falls | none | 6 |
• Adoption • Reach to residents |
• Rate of assessing fall risk and prescribing Vitamin D S • Rate of fall risk reduction strategies and prescribing Calcium NS |
Falls rate NS |
| Dolansky, 2013 [104] | US, 4 NHs | Heart failure | none | 6 |
• Reach to residents • Perceptions |
Rate of heart failure treatment in one but not all NHs NR | none |
| Edwards, 2017 [105] | Australia, 7 NHs | Wound and skin care | Champions for Skin Integrity | 5 | • Perceptions | Rate of wound management and prevention strategies S | The rate of wounds S |
| Fallon, 2006 [106] | Australia, 2 NHs | Oral health | none | 6 |
• Reach to staff • Perceptions |
Staff knowledge of 2 but not all oral health care procedures S | none |
| Fine, 2014 [107] | US 8 NHs | Pain | none | 5 |
• Reach to staff and residents • Perceptions |
• Care plan with pain goals, S • Other processes, NS |
none |
| Fitzler, 2016 [39] | US, 30 NHs | Dementia care | none | 6 | • Perceptions | Scores on 9 of 10 quality indicators S | Rate of ‘resident-on-staff’ altercations S |
| Hartmann, 2018 [40] | US, 6 NHs | Person-centered care | LOCK model | 6 |
• Reach to residents • Perceptions |
Number of opportunities for staff and resident interactions S | Rate of negative staff and resident interactions NS |
|
Hickman, 2016 [108]; Ersek, 2018 [109] |
US, 19 NHs |
Advance care planning | OPTIMISTIC | 8 |
• Reach to staff and residents • Perceptions |
Rate of advance care planning and changes in written advance care plans NR | none |
| Horn, 2010 [110]; Sharkey, 2013 [111] | US, 11 NHs | Pressure ulcers | Real-Time | 7 |
• Reach to residents • Fidelity • Perceptions |
Time that certified nursing assistants stayed late to complete documentation S | Rate of high risk residents with pressure ulcers and the rate of new pressure ulcers S |
| Horner, 2005 [112] | US, 9 NHs | Pain | none | 3 | • Adoption |
• Rate of pain assessment and non-pharmacologic pain treatment S • Rate of pharmacologic pain treatment NS |
none |
| Keeney, 2008 [113] | US, 4 NHs | Pain | none | 6 | • Sustainment |
• Rate of pain assessment S • Rate of pain treatment NS |
none |
| Kezerian, 2018 [114] |
Canada, 15 NHs |
Hospital transfers | Palliative Care in Residential Care Initiative | 5 |
• Reach to staff • Perceptions |
Rate of 1 of 5 advance care planning services S | Rate of hospital transfers NS |
| Kovach, 2008 [115] | US, 8 NHs | Pain | Serial Trial Intervention | 3 |
• Reach to staff • Perceptions • Sustainment |
Rate of pain assessment and treatment S | Rate of behavioral symptoms NR |
| Lai, 2018 [116] | Taiwan, 11 NHs | Hand hygiene | none | 6 |
• Reach to residents • Fidelity |
none | The patient infection density S |
| Lynn, 2007 [117] | US, 35 NHs | Pressure ulcers | 8 | • Adoption | Rate of pressure ulcer risk assessment S |
• Rate of Stage III and IV pressure ulcers S • Rate of Stage I and II pressure ulcers NS |
|
| Ouslander, 2009 [118] |
US, 3 NHs |
Hospital transfers | INTERACT II | 7 | • Perceptions | none | Rate of hospital transfers NR |
| Rask, 2017 [91] |
US, 105 NHs |
Hospital transfers | INTERACT II | 5 | • Perceptions | none | Hospital transfers in 2 of 3 organizations S |
|
Rosen, 2005 [119]; Rosen, 2006 [120] |
US, 2 NHs | Pressure ulcers | none | 6 | • Reach to staff | none |
• Rate of pressure ulcers (Stage II or greater) S • Rate of pressure ulcers equivalent for Black and White residents, S |
| Sand, 2007 | US, 15 NHs | Staff immunization | none | 5 |
• Adoption • Perceptions |
Rate of immunization, NS | none |
| Scott-Cawiezell, 2009 [121] | US, 5 NHs | Nursing care | none | 5 |
• Reach to residents • Perceptions |
Monitoring implementation of an electronic medical records system NR | none |
| Simmons, 2013 [122] | US, 2 NHs | Weight loss | none | 9 |
• Reach to staff and residents • Perceptions |
Quantity of food consumed and the rate staff offered alternative meal choices S | Daily weight loss NS |
| Tena-Nelson, 2012 [123] | US, 18 NHs | Hospital transfers | INTERACT | 5 |
• Adoption • Reach to staff and residents • Perceptions |
Rate staff used tools for monitoring and communicating changes in health NR | Rate of hospital transfers NS |
| Torma, 2014 [124] | Sweden, 4 NHs | Nutrition | none | 6 | • NR | none | Nutritional status scores NS |
| Triller, 2014 [125] | US, 12 NHs | Anti-coagulant therapy | none | 7 |
• Adoption • Perceptions |
Rate of timely post-antibiotic prescribing international normalised testing S | none |
| Wilson, 2018 [126] |
England 2 NHs |
Hydration | none | 3 | • Perceptions | Rate fluids offered NR | Rate of adverse health events NR |
| Zubkoff, 2018 [127] | US, 21 NHs | Falls | none | 7 | • Perceptions | Rate of “post-fall’ huddles NR | Falls rate NS |
Key: a nursing home, b intervention