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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., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Objectives: The burden of potential dementia cases without formal diagnosis on the health care system is almost unknown. This study examined the impact of potential dementia without formal diagnosis on the rate of visits to hospital emergency department (ED) of nursing home (NH) residents., Design: Cross-sectional study., Setting: NHs (175) located in France., Participants: A total of 5684 subjects who were living in the NH for at least 1 year., Measurements: Information on NHs' characteristics and on NH residents' health was recorded by NH staff. Participants were divided in 3 groups according to their dementia status: diagnosed dementia, potential dementia without formal diagnosis, and nondementia. The outcome measure was a binary variable: ED visits in the last 12 months (yes vs no). A mixed-effects logistic regression was performed on ED visits accounting for the random effects of living in a particular NH., Results: From the 5684 participants, 1036 had been seen in the ED. Adjusted odds ratio (AOR) showed that having a potential dementia without formal diagnosis, compared with a diagnosed dementia, was associated with an increased probability of ED visits (AOR = 1.25, 95% confidence interval: 0.99-1.59, P = .061); however, when a random NH effect was entered into the model, the association between potential dementia without formal diagnosis and ED visits disappeared (AOR = 1.22, 95% confidence interval: 0.95-1.57, P = .11)., Conclusion: The association of potential dementia without formal diagnosis with ED visits varies across NHs. This intra-NH aspect (eg, organization and care habits) should be taken into account when examining the rates of hospitalization and possibly the use of health care services in general among NH residents., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: Very scarce information is available about the use of proton-pump inhibitors (PPI) in nursing homes (NH). This study investigated the factors associated with PPI use among NH residents., Design: Cross-sectional, Setting: One hundred seventy-five NHs in Midi-Pyrénées region, South-Western France., Participants: Data was collected for 6275 NH residents. Participants (73.7% women) were aged 86 years (± 8.2)., Measurements: NH staff sent participants' drug prescriptions to research team; they also recorded information on residents' health characteristics. A binary logistic regression was performed on PPI use., Results: PPI use was highly prevalent (n = 2 370, ie, 37.8%). Whilst peptic ulcer (OR 4.741; 95% CI 3.647-6.163) and nonsteroidal anti-inflammatory drugs (OR 2.124; 95% CI 1.528-2.951) were important indicators of PPI use, they explained just a small fraction of PPI prescriptions; most prescriptions were probably inappropriately related to a general condition of health vulnerability, reflected by polypharmacy and comorbidities., Conclusions: Vulnerable people take PPIs more often in NHs. Physicians must be aware about the health risks possibly induced by inappropriate PPI use when prescribing these drugs for NH residents., (Copyright © 2013. Published by Elsevier Inc.)

Background: Whilst the number of people living in nursing homes (NH) is expected to rise, research on NH quality is scarce. The purpose of this article is to describe the research protocol of the IQUARE study and to present its baseline data., Methods and Design: IQUARE is a 18-month multicentric individually-tailored controlled trial of education and professional support to NH staff. The main purposes of IQUARE are to improve the quality of the health care provided in NHs and to reduce the risk of functional decline among residents. Data on internal organisation and residents' health for the 175 participating NHs were recorded by NH staff at baseline. NHs were allocated to either a light intervention group (LIG, n = 90 NHs, totalising 3 258 participants) or a strong intervention group (SIG, n = 85 NHs, totalising 3 017 participants). Intervention for LIG consisted at delivering to NH staff descriptive statistics on indicators of quality regarding their NH and the NHs from their sub-region of health and region; whereas for SIG, NH staff received the same information that LIG, but quality indicators were discussed by a cooperative work (two half-day meetings) between a hospital geriatrician and NH staff. Strategies for overcoming NH's weaknesses were then traced; the efficacy of strategies is evaluated at a 6-month period., Results: Baseline data showed high levels of dependence, comorbidities, psychological disturbances and medication's consumption among NH residents. Large discrepancies among NHs were observed., Conclusions: IQUARE is one of the largest controlled trials in NHs developed in France. Results from IQUARE may constitute the basis for the development of new work modalities within the French health system, and serve as a model of a feasible research approach in NHs.

Objectives: Little information is available about associations between nursing home (NH) structural and organizational aspects and benzodiazepine prescriptions, particularly for long-acting drugs. This study addressed this knowledge gap., Design: Cross-sectional study., Setting: One hundred seventy-five NHs from France., Participants: A total of 6275 NH residents, aged 86 years (± 8.2), and mostly women (73.7%)., Measurements: Outcome measures were: (1) benzodiazepine and (2) long-acting benzodiazepine use. NH staff sent to research team all drug prescriptions in the week participants were included in the study; staff also recorded information on residents' characteristics, and NHs structure and internal organization. Binary logistic regressions were performed separately on total and long-acting benzodiazepine., Results: A total of 3350 persons took benzodiazepine; 577 took long-acting benzodiazepine. Subject-related characteristics were the main correlates of benzodiazepine use. NH characteristics were also related to this outcome: number of beds ≥ 91 (Odds Ratio (OR) 0.820, 95% Confidence Interval (CI) 0.682-0.986), special care unit (OR 1.131, 95% CI 1.000-1.279), pharmacy for internal usage (OR 1.341, 95%CI 1.128-1.594), and date records of the first prescription of psychotropics (OR 1.394, 95% CI 1.209-1.607). Pharmacy for internal usage was also associated with long-acting benzodiazepine (OR 1.374, 95% CI 1.076-1.754)., Conclusions: NH structure- and organization-related indicators impact benzodiazepine use among NH residents. This finding is of particular importance because these indicators are more easily modifiable than subject-related characteristics. Therefore, NH directors and medical staff should be aware about this to implement feasible modifications for reducing inappropriate and chronic benzodiazepine use., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)