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Table 4 Relationship between structural, process and outcome indicators of nutritional care

From: Process, structural, and outcome quality indicators of nutritional care in nursing homes: a systematic review

1st Author, Year of publication Risk adjustment Main results
Bonaccorsi, 2015 [35] Age, gender, the Barthel Index score, the Pfeiffer test score, the EBS score, where the subject consumed lunch on the day of the survey Among the process and structural indicators included in the study, the only one with a role in predicting malnutrition was the availability of a scale suitable for weighing residents even in the case of mobility restriction (chair or platform scale).
Dyck, 2007 [39] Residents’ case-mix: end of life, depression, swallowing problem, renal failure, diabetes mellitus Staffing hours affect weight loss: residents receiving at least three hours/day of nursing assistant care had a 17% decreased likelihood of weight loss.
Hurtado, 2016 [40] High-risk residents’ adjustment at facility level (not described). Schedule control was not associated with weight loss.
Meijers, 2014 [36] NO Only the interacted process indicators nutritional screening and oral nutritional supplementation were significant in influencing malnutrition prevalence rates over time. Structural indicators had no impact on the malnutrition prevalence over time.
Rantz, 2009 [29] NO ‘At risk’ facilities (defined using quality indicators derived from MDS) accepting one or more visits improved weight loss quality indicators by 4%.
Shin, 2015 [42] NO Hours per resident per day, skill-mix hours per resident per day, and staff turnover are not statistically associated with weight loss.
Van Nie, 2014 [37] NO Five structural quality indicators influenced malnutrition prevalence in NH residents at the ward level: presence of at least one nurse in the ward specialized in the area of malnutrition; nutrition assessment upon admission; inclusion in the care file of the assessment as to the risk of malnutrition for each client; provision of a protein- and energy-enriched diet in case of (expected) malnutrition, in accordance with a standard procedure; inclusion in the care file of the intake for each client.
van Nie-Visser, 2015 [38] NO Two structural quality indicators of nutritional care at ward level influence malnutrition prevalence in NH residents: the policy that a care file should include the nutritional intake for each resident and the policy for ward having a weight measurement.
Werner, 2013 [43] Data controlled for case-mix and for facility-level characteristics related to residents’ case-mix: • Age • Activity of Daily Living • Cognitive performance scale • % of residents who needs radiation therapy, chemotherapy, dialysis, intravenous therapy, respiratory treatments, tracheostomy care, ostomy care, suctioning, injections The statistically significant improvement in weight loss indicator could not be explained by changes in the investigated measures of process of care (% of residents receiving tube feeds; % of residents receiving mechanically altered diets; % of residents with assisted eating devices).
  1. EBS Eating Behaviour Scale, MDS Minimum Data Set, OSCAR Online Survey, Certification, and Reporting