Data Quality of Resident Documentation in Long-Term Care: A Systematic Review and Meta-analysis

Abstract

Objectives

To evaluate the impact of interventions aimed at improving data quality in resident documentation in the residential long-term care setting, and to explore the experiences related with the implementation strategies and key determinants influencing data quality.

Design

A systematic review.

Setting and Participants

Residential long-term care.

Methods

PubMed and Embase were searched from inception to January 2025. This search was supplemented with screening study registries, references, prospective citation searching, and reviewing gray literature. Studies were selected and data were abstracted by 2 researchers. A narrative synthesis and random effects meta-analyses were performed. The GRADE level of evidence was determined. A thematic analysis was conducted for the qualitative data.

Results

A total of 30 studies were included. The introduction of electronic health records, educational strategies, incident reporting systems, and reminder strategies were associated with small to moderate improvements. The average effect across interventions was an improvement of 13% (95% CI, 7%–20%, I² = 60%, very low GRADE) in data completeness. Overall data quality was improved in 3 studies, accuracy of data was improved in 1 study, and 1 study observed a nonsignificant improvement in reliability. Small effect sizes and very low-GRADE evidence were observed. Key determinants influencing data quality included the perceived usefulness of documentation systems, access to electronic health records, staff knowledge about clinical assessments, and perceptions of the appropriateness of quality indicators and data reliability. Implementation of interventions was supported by the following strategies: (1) identify and prepare champions, (2) audit and feedback on implementation, (3) provide ongoing consultation, and (4) disseminate implementation materials.

Conclusions and Implications

Small to moderate improvements in data quality were observed, with a very low GRADE of evidence. Most findings were limited to the completeness of documentation, although aspects such as timeliness and accuracy remain understudied. It remains unclear what interventions are effective in ensuring solid data quality.