How Have Quality Improvement Strategies Been Adopted and How Has Impact Been Assessed in Care Homes for Older People? A Systematic Search and Narrative Review.
Fiona Cowdell, Hannah Harvey, Judith Dyson
PMID 40911387WHAT IT FOUND
Care home quality improvement projects reported variable short-term changes in medication, pressure injuries, falls or admissions, but impact was often modest and residents were not explicitly involved.
Key findings
01The review included 44 empirical care home quality improvement papers published after January 2019.
02Included studies commonly targeted prescribing and medication use (n = 8), pressure injuries (n = 7), assessment practices (n = 5), end-of-life care (n = 5), resident experience (n = 5), hospital admissions (n = 5) and falls (n = 4).
03Adoption studies generally reported quantitative outcomes of varying impact, usually short term and not generalisable because of small sample numbers.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No protocol was prepared or registered, and grey literature was excluded, so the search may have missed relevant projects. Only English-language peer-reviewed studies published after January 2019 were included, limiting generalisability. The included studies were heterogeneous care home quality improvement projects, not controlled trials, and many had small samples and short-term outcomes. Impact was variable and often modest or poorly reported, and some studies reported no measurable improvement. Residents were not explicitly included in the improvement efforts, so resident priorities may be underrepresented.
Declared interests
The authors declared no conflicts of interest and reported nothing to disclose.
The easy way to misread this
Do not read this as proof that quality improvement reliably improves care home outcomes. The review found variable, often short-term and modest changes, with limited reporting and no explicit resident involvement, so it mainly shows what has been attempted rather than what works.