Abstract
BackgroundThe quality of nursing homes (NHs) has attracted a lot of interest in recent years and is one of the most challenging issues for policy-makers. Nutritional care should be considered an important variable to be measured from the perspective of quality management. The aim of this systematic review is to describe the use of structural, process, and outcome indicators of nutritional care in NHs and the relationship among them.MethodsThe literature search was carried out in Pubmed, Embase, Scopus, and Web of Science. A temporal filter was applied in order to select papers published in the last 10 years. All types of studies were included, with the exception of reviews, conference proceedings, editorials, and letters to the editor. Papers published in languages other than English, Italian, and Spanish were excluded.ResultsFrom the database search, 1063 potentially relevant studies were obtained. Of these, 19 full-text articles were considered eligible for the final synthesis. Most of the studies adopted an observational cross-sectional design. They generally assessed the quality of nutritional care using several indicators, usually including a mixture of many different structural, process, and outcome indicators. Only one of the 19 studies described the quality of care by comparing the results with the threshold values. Nine papers assessed the relationship between indicators and six of them described some significant associations—in the NHs that have a policy related to nutritional risk assessment or a suitable scale to weigh the residents, the prevalence or risk of malnutrition is lower. Finally, only four papers of these nine included risk adjustment. This could limit the comparability of the results.ConclusionOur findings show that a consensus must be reached for defining a set of indicators and standards to improve quality in NHs. Establishing the relationship between structural, process, and outcome indicators is a challenge. There are grounds for investigating this theme by means of prospective longitudinal studies that take the risk adjustment into account.
Highlights
The quality of nursing homes (NHs) has attracted a lot of interest in recent years and is one of the most challenging issues for policy-makers
Most of the studies used standardized questionnaires or instruments to collect data on quality indicators, either routinely applied at a state level for mandatory reasons (MDS, Victorian Public Sector Residential Aged Care Services [VPSRACS]), or implemented as an annual measurement of malnutrition prevalence and structural quality indicators of nutritional care in the NHs that voluntarily decided to participate to the study (LPZ)
The prevalence or risk of malnutrition is associated with aspects such as having a policy related to nutritional risk assessment or having suitable scales to weight the residents; when these aspects are present or used in NHs, the prevalence or risk of malnutrition is lower
Summary
The quality of nursing homes (NHs) has attracted a lot of interest in recent years and is one of the most challenging issues for policy-makers. The use of structural and process indicators for quality management offers several advantages — they are generally easy to measure and interpret and the collected data are often routinely available They might not reflect the level of the quality of care; structural and process indicators indicate the attributes of the NH and what is being done (or is supposed to be done), but they do not automatically translate into a higher quality of care or better outcomes. Outcome indicators overcome these limitations and are considered to be more closely related to quality They are influenced by the risk level of elderly patients—primarily due to their health status—as well as by the quality of the care process. Outcome indicators have to be risk-adjusted [7, 11]
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