Study designs of evaluations included in the review
Randomised controlled trials, pre-test, time series and post-test only studies were eligible for inclusion.
Specific interventions included in the review
The studies included in the review concerned quality system activities; for example, the provision of feedback on outcomes, the implementation of guidelines, the assessment of resident needs using care plans, internal audit, tuition and an ombudsman for the residents.
Participants included in the review
Long-term care nursing home residents and the health professionals delivering care. The number of nursing homes participating in the studies ranged from 1 to 268. There were 13 studies of 1 to 16 homes, 2 studies of 60 nursing homes, and 6 studies with more than 200 participating nursing homes.
Outcomes assessed in the review
The studies reported on: (1) the effectiveness of specific educational programmes; (2) the effectiveness of two different facility and resident assessment processes on the overall quality of care and the detection of problems; and (3) the impact of working within quality assurance cycles. The specific outcomes related to each of these processes included: psychotropic drug use and delivery errors; rates of infections, especially urinary tract infection; the prevalence of pressure sores and incontinence in residents; fall rates; and physical status measures such as hydration and nutrition status. Cognitive and psychosocial well- being were also assessed. Studies that included no description of the impact of the quality systems activity on the process or outcome measures (resident satisfaction and health outcomes of residents) were excluded.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.