How Have Quality Improvement Strategies Been Adopted and How Has Impact Been Assessed in Care Homes for Older People? A Systematic Search and Narrative Review

IF 2 4区医学 Q4 GERIATRICS & GERONTOLOGY

International Journal of Older People Nursing Pub Date : 2025-09-05 DOI:10.1111/opn.70036

Fiona Cowdell, Hannah Harvey, Judith Dyson

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Abstract

Introduction

We conducted a systematic search and narrative review of quality improvement in care homes. Our aim was to examine how quality improvement strategies have been adopted and how impact has been assessed in care homes for older people.

Methods

Following PRISMA guidelines, we conducted systematic searches of the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO and Applied Social Sciences Index & Abstracts (ASSIA) (2019–2024). We replicated the search strategy of a previously published review. Three co-authors undertook selection and data extraction.

Results

Forty-four articles were included describing varied stages of quality improvement initiatives in care homes. The United States produced the largest number of studies. Quality improvement strategies were often poorly reported. Included papers reported stages of quality improvement from inception to evaluation. Most aimed for improved clinical outcomes, mainly those subject to external scrutiny. Few studies reported impact robustly. Quantitative measures, surveys and qualitative data were reported alongside staff-reported changes. There was no evidence of sustained improvement. There is some evidence of the use of theories, models and frameworks usually associated with implementation and knowledge mobilisation.

Conclusion

Current improvement practice is inconsistent and having limited impact.

Implications for Practice

We recommend any initiative to enhance resident experience and outcomes should involve establishing a project team, moving away from a deficit model, prioritising areas for improvement, identifying best practice, deciding how to measure improvement, understanding the challenges to best practice, co-designing strategies to effect change, sustaining the improvement, sharing learning and providing clear, detailed and accessible reporting.

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长者护理院如何推行质素改善策略及评估成效？一个系统的搜索和叙述评论

我们对养老院的质量改善进行了系统的搜索和叙述回顾。我们的目的是研究老年人护理院如何采用质量改进策略以及如何评估其影响。方法按照PRISMA指南，系统检索2019-2024年中国护理与相关健康文献累积索引（CINAHL）、Medline、PsycINFO和应用社会科学索引文摘（ASSIA）等电子数据库。我们复制了先前发表的综述的搜索策略。三位共同作者进行了选择和数据提取。结果共纳入44篇文章，描述了护理院质量改善措施的不同阶段。美国的研究数量最多。质量改进策略通常没有得到很好的报道。包括报告从开始到评估的质量改进阶段的论文。大多数旨在改善临床结果，主要是那些受到外部审查的结果。很少有研究有力地报道了影响。除了工作人员报告的变化外，还报告了定量措施、调查和定性数据。没有持续改善的证据。有一些证据表明，理论、模型和框架的使用通常与实施和知识动员有关。结论目前的改进实践不一致，效果有限。我们建议任何提高住院医师经验和成果的举措都应包括建立一个项目团队，摆脱赤字模式，优先考虑需要改进的领域，确定最佳实践，决定如何衡量改进，了解最佳实践面临的挑战，共同设计影响变革的策略，保持改进，分享学习经验并提供清晰，详细和可访问的报告。

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来源期刊

International Journal of Older People Nursing Nursing-Gerontology

CiteScore

3.60

自引率

9.10%

发文量

期刊介绍： International Journal of Older People Nursing welcomes scholarly papers on all aspects of older people nursing including research, practice, education, management, and policy. We publish manuscripts that further scholarly inquiry and improve practice through innovation and creativity in all aspects of gerontological nursing. We encourage submission of integrative and systematic reviews; original quantitative, qualitative, and mixed methods research; secondary analyses of existing data; historical works; theoretical and conceptual analyses; evidence based practice projects and other practice improvement reports; and policy analyses. All submissions must reflect consideration of IJOPN''s international readership and include explicit perspective on gerontological nursing. We particularly welcome submissions from regions of the world underrepresented in the gerontological nursing literature and from settings and situations not typically addressed in that literature. Editorial perspectives are published in each issue. Editorial perspectives are submitted by invitation only.