Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators

Physical Disability Clinical Trial

— IQUARE  

Official title:

Impact of Either Audit and Feedback Only or Audit and Feedback Associated to Cooperative Work Meetings Between Hospital Geriatricians and Nursing Home Staff on Quality Indicators and Health Care Practices in Nursing Homes.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01703689
• Other study ID #: ARSMP.2010.1
• Status: Completed
• Phase: N/A
• First received: September 27, 2012
• Last updated: July 18, 2016
• Start date: May 2011
• Est. completion date: March 2013

Study information

• Verified date: July 2016
• Source: Agence Régionale de la Santé - Midi Pyrénées
• Contact: n/a
• Is FDA regulated: No
• Health authority: France: Ministry of HealthUnited States: Federal Government
• Study type: Interventional

Clinical Trial Summary

Introduction: Efficacy of audit and feedback interventions on nursing home (NH)quality indicators is not well-established.

The main objective: The main purpose of the IQUARE study was to examine the impact of two types of audit and feedback interventions on NH quality indicators and on residents dependence levels in a 18-month follow-up.

Study hypothesis: We hypothesised that audit and feedback associated to educational and professional supportive interventions are more efficacy in improving NH quality indicators than audit and feedback only.

Secondary objectives: Investigate the impact of the interventions on

1. Residents:

• Functional decline rate

• Drug prescriptions (quantity and quality)

• Prevalence of adverse health outcomes (e.g., falls)

2. NHs:

• Planning and implementation of therapeutic measures

Description:

IQUARE is a multicentric individually-tailored controlled trial comparing two types of audit and feedback interventions:

• audit and feedback associated to cooperative work meetings between hospital geriatricians and nursing home (NH) staff in a 6-month intervention (strong intervention)

• audit and feedback only (light intervention) Power statistics and sample size calculations indicated that each group should be composed of at least 2 500 individuals. The strong intervention will last 6 months and is composed of two face-to-face cooperative meetings (hospital geriatricians and NH staff). Data will be collected at baseline and in a 18-month follow-up.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 8039
• Est. completion date: March 2013
• Est. primary completion date: July 2011
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Nursing homes (NH) voluntarily accepted to participate in the study.

• NH residents of both sex

• Residents living in the NH for = 30 days

• Residents and their general practitioner (GP) having received information about the study

• NH residents do not voluntarily decline to participate in the study

Exclusion Criteria:

• NH currently participating in another interventional study

• GP of NH residents refused participation in the study.

Study Design

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Physical Disability
• Quality Indicators

Intervention

Behavioral:
• Audit and Feedback
Descriptive statistics to each nursing home (NH) with regards to its own indicators of quality and residents' health status, and the same descriptive statistics on the sub-regional and regional levels were done to all NHs for comparative purposes.
• Cooperative Work
Nursing homes (NH)in the strong intervention group had two half-day meetings of cooperative work with a hospital geriatrician to identify NHs' weaknesses regarding quality of care and to establish strategies for overcoming these weaknesses.

Locations

Country	Name	City	State
France	EHPAD le parc ALBI	Albi
France	EHPAD Canarie Vieuzac	Argelès-Gazost
France	MAPAD Les Pradels	Assier
France	Les Jardins auscitains	Auch
France	Les jardins d´Agape	Auch
France	Saint Dominique	Auch
France	EHPAD Résidence Mutualiste La Pyrénéenne	Aureilhan
France	EHPAD Résidence Castelmouly	Bagnères-de-Bigorre
France	ONAC résidence paul oddo	Barbazan
France	Korian Les Ainés du Lauragais	Baziège
France	Notre Dame	Beaumont-de-Lomagne
France	Ehpad Sherpa	Belmont-sur-Rance
France	Le Pastel	Bessières
France	Le Pastourel	Bessières
France	Sainte-Cécile	Bessières
France	Emeraude	Blagnac
France	Résidence de Vinci	Blagnac
France	EHPAD St joseph de BRASSAC	Brassac
France	EHPAD Robert Durrieu	Bretenoux
France	M.R Orpea	Cahors
France	EHPAD La Cascade	Cajarc
France	Les Roses	Calmont
France	EHPAD Gai Logis	Capdenac-Gare
France	EHPAD La Croix Bleue	Capdenac-gare
France	EHPAD le bosc Carmaux	Carmaux
France	Tour Tottier	Castelginest
France	La Cerisaie	Castelmaurou
France	Notre Dame du Bon Accueil	Castelnau-d´Estrétefonds
France	M.R St Luc - Castelnau Montratier	Castelnau-Montratier
France	Chic Ehpad C.H	Castelsarrasin
France	EHPAD Villégiale Saint Jacques CHIC - CASTRES/MAZAMET	Castres
France	MAPA Résidence St Astier	Catus
France	EHPAD Caylus - Val de Bonnette	Caylus
France	EHPAD Arc-En-Ciel	Cazals
France	Jeanne Penent	Cazères
France	Castelgirou	Cépet
France	ALLIANCE	Cologne
France	EHPAD St Laurent	Cruejouls
France	EHPAD les arcades	Dourgne
France	EHPAD Saint-Philippe	Ercé
France	Saint-Joseph	Fronton
France	EHPAD St ANDRE CH de Gaillac	Gaillac
France	EHPAD St JEAN CH de Gaillac	Gaillac
France	EHPAD Accueil du Frère Jean	Galan
France	EHPAD La Baïse	Galan
France	Ch Gimont	Gimont
France	Foyer Pierre Bonhomme	Gramat
France	MR Charles de Gaulle	Gramat
France	MR Louis Conte	Gramat
France	EHPAD Saint Dominique	Gramond
France	Ehpad de Graulhet	Graulhet
France	Saint-Jacques	Grenade
France	Ste Sophie	Grisolles
France	EHPAD Résidence Zélia	Ibos
France	EHPAD Le Jonquère	Juillan
France	EHPAD Faux-Bourg Saint-Adrien	L´ Isle-en-Dodon
France	Saint-Jacques	L´ Isle-Jourdain
France	EHPAD Gustave Pédoya	La Bastide-de-Sérou
France	EHPADRouanet-Iché de LABASTIDE-ROUAIROUX	Labastide-Rouairoux
France	EHPADL'Oustal d'En Thibaud	Labruguière
France	M.R La Miséricorde	Lacapelle-Marival
France	EHPAD St vinçent de paul	Lacaune
France	Résidence du Lac	Lafrançaise
France	EHPAD résidence le grand champ	Lagrave
France	Les Causeries	Laguépie
France	Centre hospitalier du Pays d´Olmes - Laroques d´Olmes	Laroques d´Olmes
France	La Barbacane	Larrazet
France	MAPAD Les Ségalines	Latronquière
France	Résidence Paul et Lisa	Launaguet
France	Ehpad Les Quietudes	Lautrec
France	Centre hospitalier du Pays d´Olmes - Résidence du Touyre	Lavelanet
France	La Vendinelle	Le Cabanial
France	Ehpad Barrere	Lectoure
France	Ehpad Feral	Lectoure
France	Résidence Curtis	Léguevin
France	EHPAD L´Oasis	Livinhac-le-Haut
France	EHPAD La Madone	Lourdes
France	EHPAD Le Petit Jer	Lourdes
France	EHPAD Notre Dame des Grâces	Lugan
France	EHPAD Le Paginet	Lunac
France	MAPAD Les logis de l´Impernal	Luzech
France	EHPAD Le santoulis	Luzenac
France	EHPAD Saint Joseph	Marcillac-Vallon
France	Val de Gers	Masseube
France	EHPAD Le Clos du Raunier	Mazères
France	MR Beau Séjour	Mercuès
France	EHPAD du CH Millau - St Michel	Millau
France	EHPAD Les Charmettes	Millau
France	EHPAD Louise de Roquelaure	Mirepoix
France	EHPAD de MONESTIES	Monestiés
France	Ange Gardien	Montauban
France	Montauban - Ehpad Ushpa	Montauban
France	MR Saint Orens	Montauban
France	St Jean Marie Vianney	Montbeton
France	MR Sainte-Marie	Montcuq
France	M.R La Roseraie	Montfaucon
France	MR L´Etoile du Soir	Montredon
France	L´Hermitage	Montréjeau
France	EHPAD Rés. Parc de la Corette	Mur-de-Barrez
France	Le Barry	Muret
France	Résidence Marie-Antoinette	Muret
France	EHPAD Résidence les deux vallées	Nant
France	EHPAD Sainte Marie les Ursulines	Nant
France	EHPAD Résidence du Lac	Orleix
France	Centre Alzheimer Marie-Louise	Pechbonnieu
France	La Houlette	Pibrac
France	La Tranquilité	Pins-Justaret
France	Cité Saint Joseph	Plaisance du Gers
France	Le Prat	Plaisance-du-Touch
France	Oasis-Palmeraie	Pointis-de-Rivière
France	EHPAD La résidence du Lac	Pont de Salars
France	L´Auta	Portet-sur-Garonne
France	EHPAD Résidence du petit bois	Pradines
France	M.R Les balcons du Lot	Prayssac
France	M.R Les Lavandes	Puy-l´Évêque
France	EHPAD la Maison Du Lac	Puygouzon
France	Résidence Isatis	Quint-Fonsegrives
France	EHPAD Hermitage et Terrasses de Rabastens	Rabastens
France	EHPAD Jean Baptiste Delfau	Requista
France	EHPAD de Revel	Revel
France	EHPAD Les Rosiers	Rignac
France	Bel Adour	Riscle
France	EHPAD Bon Accueil	Rodez
France	EHPAD Julie Chauchard	Rodez
France	EHPAD Saint Cyrice	Rodez
France	EHPAD Saint Jacques du CH	Rodez
France	EHPAD Le clos de Siloe	Roquecourbe
France	EHPAD La Miséricorde	Saint-Affrique
France	Les Clos des Amandiers	Saint-Alban
France	Résidence de l´abbaye	Saint-Antonin-Noble-Val
France	Lavallée	Saint-Clar
France	EHPAD Les Galets d´Olt	Saint-Côme-d´Olt
France	L´Ensoleillade	Saint-Gaudens
France	Le Mas Saint-Pierre	Saint-Gaudens
France	EHPAD de l´Hôpital local	Saint-Geniez-d´Olt
France	Centre hospitalier Ariège Couserans	Saint-Girons
France	EHPAD Le Val d´Olt	Saint-Laurent-d´Olt
France	EHPAD Hector d´Ossun	Saint-Lizier
France	Les Rossignols	Saint-Lys
France	Maréchal Leclerc	Saint-Lys
France	Résidence La Joie de Vivre	Saint-Lys
France	EHPAD Clos St François	Saint-Sernin-sur-Rance
France	Ehpad Chez Nous	Saint-Sulpice
France	EHPAD Les grands chênes	Saïx
France	EHPAD Petite Plaisance SAVAGNAC	Salvagnac
France	EHPAD Vert Coteau	Saverdun
France	EHPAD Paul Ané	Seix
France	La Septfontoise	Septfonds
France	Ehpad Le Pre Fleuri	Serviès
France	EHPAD Sainte Marie	Siradan
France	EHPAD St Vinçent et Ste Croix	Sorèze
France	EHPAD St Jean	St AMANS DES COTS
France	Arc-en-Ciel	Toulouse
France	Caroline Baron	Toulouse
France	EHPAD Les Fontaines	Toulouse
France	La Cotonnière	Toulouse
France	La Pastellière	Toulouse
France	Les Tourelles	Toulouse
France	Maurice Garrigou	Toulouse
France	Orpéa Crampel	Toulouse
France	Plénitude Saint-Michel	Toulouse
France	Résidence Saint-Simon	Toulouse
France	Le Grand Marquisat	Tournefeuille
France	Ehpad Belcantou	Trébas
France	EHPAD Résidence Les Rives du Pélam	Trie-sur-Baïse
France	EHPAD du Centre Hospitalier Des Deux Rives	Valence D Agen
France	M.R Résidence Valpré	Vayrac
France	EHPAD ND de Touscayrats	Verdalle
France	MR Saint Jacques	Verdun-sur-Garonne
France	EHPAD La Clairière - Les Acacias	Vic-en-Bigorre
France	Ch Vic-Fezensac	Vic-fezensac
France	Le Château fleuri	Vic-Fezensac
France	EHPAD Sainte Claire	Villefranche-de-Rouergue
France	EHPAD Sud Rulhedu CH	Villefranche-de-Rouergue
France	Le Pin	Villeneuve-Tolosane

Sponsors (2)

Lead Sponsor	Collaborator
Agence Régionale de la Santé - Midi Pyrénées	Observatoire Régional de la Santé Midi-Pyrénées (ORSMIP)

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Reduction in the prescription of psychotropic drugs from baseline to 18-month follow-up	It will be examined if the rate of antidepressants, anxiolytics, antipsychotics, and hypnotics/sedatives (coded according to the Anatomical Therapeutic Chemical classification. Information available at: http://www.whocc.no/atc_ddd_index/) prescriptions will be reduced between baseline and follow-up. A particular attention will be given to the prevalence of people taking 3 or more psychotropics (increased risk of drug-drug interaction and adverse drug reaction) and to the use of these medications among people with dementia.	baseline and 18-month follow-up	No
Primary	Change from baseline in nursing home quality indicators at 18 months	Indicators of quality of care in 10 main outcomes: dementia (e.g.,prevalence of cognitive assessment), behavioural disturbances (e.g., prevalence of behavioural disturbances assessment), restraining (e.g., prevalence of restrained residents with a medical prescription for restraining), mood (e.g., prevalence of mood assessment), osteoporosis and falls (e.g., systematic analysis of fall records), nutrition (e.g., prevalence of residents who were weighed = 3 times in the last 3 months), pressure ulcers (e.g., prevalence of residents who were evaluated for the risk of pressure ulcers), pain (e.g., prevalence of residents who were evaluated for pain among residents in end-of-life), medication (e.g., prevalence of re-evaluation of residents' drug prescriptions among residents who take psychotropic), and care and services (e.g., prevalence of hospitalisations in the emergency department in the last 12 months).	baseline and 18-month follow-up	No
Secondary	Onset of dependence in activities of daily living from baseline to 18 months follow-up	Onset of dependence will be measured using the 6-item Katz ADL scale. Activities examined are: bathing, dressing, transferring, walking inside home, incontinence, and eating/drinking. Ability in executing each activity will be set as: "able to execute alone, without difficulty", "able to execute alone, with some difficulty", or "needing help to execute or unable to execute".	baseline and 18-month follow-up	No