International comparison of quality indicators in United States, Icelandic and Canadian nursing facilities.

AIM: To discuss the results of a comparison using minimum data set (MDS)-based quality indicators (QIs) for residents in nursing facilities in three countries (Iceland; Ontario, Canada; and Missouri, United States) together with implications regarding nursing practices and resident outcomes in these countries. METHOD: Data were extracted from databases in each country for four consecutive quarterly periods during 1997 and 1998. All facilities investigated had the required consecutive quarterly data. Analytical techniques were matched to measure resident outcomes using the same MDS-based QIs in the three countries. RESULTS: Similarities among the three countries included the use of nine or more multiple medications, weight loss, urinary tract infection, dehydration, and behavioural symptoms that affect others. Differences among the three countries included bowel and bladder incontinence, indwelling catheter use, fecal impaction, tube feeding use, development of pressure ulcers, bedridden residents, physical restraint use, depression without receiving antidepressant therapy, residents with depression, use of anti-anxiety or hypnotic drugs, use of anti-psychotic drugs in the absence of psychotic and related conditions, residents spending little or no time in activities, and falls. CONCLUSIONS: Comparisons highlighted differences in clinical practices among countries, which may account for differences in resident outcomes. Learning from each other's best practices can improve the quality of care for older people in nursing homes in many countries.

International field test results of the Observable Indicators of Nursing Home Care Quality instrument.

Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated for use in Iceland and used in Canada. Results of the validity and reliability studies using the instrument in 12 nursing homes in Reykjavik, in a large Veterans Home in Ontario with 14 units tested separately, and in 20 nursing homes in Missouri, are promising. High-content validity was observed in all countries, together with excellent inter-rater reliability and coefficient alpha. Test-retest reliabilities in Iceland and Missouri were good. Results of the international field test of the Observable Indicators of Nursing Home Care Quality instrument points to the usefulness of such an instrument in measuring nursing home care quality following a quick on-site observation in a nursing facility. The instrument should be used as a facility-wide assessment of quality, rather than for individual units within a facility. We strongly recommend its use by practising nurses in nursing homes to assess quality of care and guide efforts to improve care. We recommend its use by researchers and consumers and further testing of the use of the instrument with regulators.

[Assessment of health and caring needs in nursing homes. The Resident Assessment Instrument, its development and some pilot study results.].

Those elderly living in institutions have multiple social, health and mental problems, in addition to loss of function. The Resident Assessment Instrument assesses the individual in detail and his caring needs. Resident Assessment Protocols come with the instrument and a handbook that describes how to evaluate specific problems further. Quality indicators allow comparisons between institutions and thus the quality of care can be assessed in comparable groups of residents. The elderly can be put into defined resource utilisation groups and an average cost calculated per unit or nursing home. A pilot study was conducted in Iceland in 1994 to examine the utility of the instrument. It was shown that most of the residents were viewed as competent according to documents, even if about half of them had considerable cognitive dysfunction. Dementia was the most common diagnosis. One fourth of the residents took antidepressant medications and 54-62% took sedatives or hypnotic drugs. Eight out of 10 had dentures and one third had difficulty chewing. Many more interesting findings showed up that are described in a special report.