Effectiveness and experiences of quality improvement interventions in older care: A mixed-methods systematic review (Preprint)

BACKGROUND Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older care settings and further improve health and social care systems OBJECTIVE This review aims to compile and synthesise the best available evidence regarding the care of older individuals and the effectiveness of policy and practice QI interventions in older care. It also aims to understand QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. METHODS The mixed-methods review will follow the standard methodology used by the Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycInfo, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of older individuals undergoing older care and any health and care professionals involved in this care delivery; a broad range of QI interventions, including assistive technologies, effects of training and education, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, i.e., PRISMA guidelines, will be followed. RESULTS The results were presented in a PRISMA flow diagram and two draft charting tables in tabular and descriptive formats. A summary of the characteristics of the included studies was then described in terms of location, study sites, timing, participants, and types of interventions. Eight kinds of QI interventions were identified: training (use of technology), education, communication, technology implementation, person-centred care, health and well-being promotion, systematic support, and competence development. The integrated synthesis yielded a range of outcomes and phenomena of interest, including staff self-efficacy, competence and skill enhancement, technology adoption, and user experience, communication and collaboration, co-designing with end users, person-centred care, health and well-being, transitional care and discharge planning, barriers to QI implementation, safety and risk reduction, peer support, and social connection, and promoting active ageing. CONCLUSIONS This comprehensive review provided insights into some QI interventions and their impact, outlined a range of outcomes and phenomena of interest for older care, and benefited both the practical usefulness of care service activities and society. Educational interventions designed for staff and older adults exemplified a promising outlook on enhancing clinical competence and promoting health literacy through various initiatives. Areas promoting health and well-being, targeting physical, mental, and social well-being, have proven to improve quality of life. INTERNATIONAL REGISTERED REPORT RR2-10.2196/56346