Rolland Yves, Mathieu Celine, Piau Christine, Cayla Françoise, Bouget Catherine, Vellas Bruno, de Souto Barreto Philipe
Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
Unité Mixe de Recherche, Institut National de la Santé et de la Recherche Médicale 1027, University of Toulouse III, Toulouse, France.
J Am Geriatr Soc. 2016 Jan;64(1):193-9. doi: 10.1111/jgs.13874.
The aim of the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes (IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home (NH) staff on quality indicators (QIs) and functional decline and emergency department (ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large-scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs.
“质量改进措施对老年护理机构中住院医生实践演变及功能衰退的影响”（IQUARE）研究的目的是检验一项全面干预措施的效果，该措施包括为养老院工作人员提供专业支持和教育，以观察其对质量指标（QIs）、功能衰退以及住院老人急诊室（ED）转诊情况的影响。法国的175家养老院（共6275名从养老院中随机选取的老人）自愿参与，并被纳入一项非随机对照多中心个体化定制试验，随访期为18个月。养老院被分配到质量审核与反馈干预组（对照组：90家养老院，3258名老人）或质量审核与反馈干预组加上医院老年病医生与养老院工作人员之间的协作工作会议组（试验组：85家养老院，3017名老人）。在养老院层面，记录了肾功能评估、认知功能、压疮风险、行为障碍、抑郁、疼痛、体重测量以及急诊室转诊的发生率。在老人层面评估了其进行基本日常生活活动的能力。基线时，养老院的质量指标普遍较低（标准差较大），急诊室年转诊率较高（约20%），且两组相似。该干预措施对压疮风险评估、抑郁、疼痛的发生率以及急诊室转诊发生率有显著的积极影响。对功能衰退没有显著影响。大规模努力改善质量指标，包括医院和养老院提供者之间的合作，并基于审核和协作讨论，是可行的，且能改善养老院护理质量的某些方面。
