Quality of Care In Nursing Homes In Brazil

Abstract

Background: There is an increased demand for nursing homes (NHs) in middle-income countries such as Brazil. To monitor the quality of NHs, there is a need for reliable instruments to assess the extent to which the care provided meets the expectations and rights of residents and their families.

Purpose: To evaluate the reliability, applicability, and measurement results of an instrument for assessing the quality of NH care assessment.

Methods: We conducted a cross-sectional study in 31 NHs, applying the Observable Indicators of Nursing Home Care Quality Instrument (OINHQ) adapted to the Brazilian context. The instrument includes 30 infrastructure and process indicators measured by direct observation grouped into seven domains: Communication; Care Delivery; Grooming; Odors; Environment-Basic; Environment-Access; and Environment-Homelike. To assess feasibility and reliability, 3 pairs of raters with different profiles (health professionals, health inspectors, and potential residents) were independently involved in data collection. We calculated Cronbach α for internal consistency of the instrument, Overall Agreement Index (OAI), and Prevalence-Adjusted Bias-Adjusted Kappa (PABAκ) for interrater reliability and analyzed the baseline NH quality through individual indicators, dimensions, and facilities.

Results: The OINHQ was in general reliable, with good internal consistency (Cronbach α = 0.93) and interrater agreement (mean OAI = 75%; PABAκ = 0.49). NH quality is not homogeneous (overall mean = 2.9, ranging by facility between 1.9 and 3.7, on a scale of 1-5). Process-related indicators (mean = 2.7) are generally worse than structure-related indicators (mean = 3.5). The best domains were associated with Odors (mean = 4.1) and Grooming (mean = 3.9), whereas the priority domains for receiving improvement interventions were Care Delivery (mean = 2.0) and Environment-Homelike (mean = 2.5).

Conclusions: Baseline evaluation of NH quality shows remarkable variability among facilities and ample room for improvement.

Keywords: Health care quality; nursing homes; patient-centered care; quality indicators; reliability and validity.