Implementation and Quality Improvement Strategies in Assisted Living: A Scoping Review

TL;DR

This review explores strategies to improve care quality in assisted living, finding that staff training and new tools show promise but more research is needed.

Contribution

The study identifies and evaluates quality improvement strategies in assisted living using Proctor’s Framework, highlighting gaps in current research.

Findings

Nine studies were identified focusing on dementia care, daily living activities, and antibiotic stewardship in assisted living.

Common strategies included staff training, new staff/tools, and rapid improvement cycles, with mixed evidence of effectiveness.

Most studies lacked detailed data on statistical power, missing data, and intervention costs.

Abstract

Gaps persist in the quality of care in assisted living (AL), yet little is known about the best approaches for closing these gaps. Guided by Proctor’s Framework for Implementation Research, this scoping review examined studies of quality improvement strategies and outcomes in AL. In collaboration with a health sciences librarian, we systematically searched PubMed, CINAHL, and Scopus to identify English-language, empirical, peer-reviewed, quality improvement and implementation studies in AL published before May 2023. Of 204 studies identified, 9 met inclusion criteria. The clinical focus of papers included behavioral expressions of persons with dementia (n = 2), activities of daily living (n = 2), and antibiotic stewardship (n = 1), among others. Strategies used to implement new clinical practices included staff training (n = 9), the addition of new staff and/or new tools (n = 8), and rapid cycles of improvement (n = 5). Studies reported outcomes related to both feasibility (n = 7), (e.g., intervention adherence, acceptability), and intervention effectiveness (n = 7), (e.g., pre- and post-intervention testing, objective observation). While sample sizes tended to be small, most interventions demonstrated preliminary evidence of effectiveness (n = 6), with only one (n = 1) reporting statistically significant outcomes. Common gaps in study reports included estimates of statistical power, details regarding missing data and unintended consequences, and the cost of the interventions. In summary, few implementation or quality improvement studies have been published on the AL setting and more empirical research is necessary to understand strategies for closing gaps in AL care quality.