National Implementation Programme – Strengthening quality of care in partnership with residential long-term care facilities for older people (NIP-Q-UPGRADE)

The National implementation programme NIP-Q-UPGRADE aims to support long-term care facilities (LTCFs) in Switzerland in data-driven quality improvement based on the national quality indicators (pain, malnutrition, physical restraints and polypharmacy). This is done by developing and implementing a national programme to improve their data quality (work package 1). When data quality is supported, a programme to support facilities with working on quality of care is developed and implemented (work package 2). Integrated in these objectives is the aim of introducing three new quality indicators (pressure ulcers, advanced care planning, medication review) in the system and evaluating and recommending indicators for future implementation (work package 3).

CURAVIVA, the industry association of ARTISET, and senesuisse manage the program on behalf of the Federal Quality Commission EQC. They have delegated the scientific management of the programme to their collaboration partner, the University of Basel, Institute for Nursing Science (INS). For its part, the INS works collaboratively with the Institut et Haute École de la Santé La Source (La Source), University of Applied Sciences and Arts Western Switzerland in Lausanne and the Centro Competenze Anziani, Scuola universitaria professionale della Svizzera italiana (SUPSI).

The programme applies the EPIS framework as a process guide, leading through the phases of exploration, preparation, implementation, and sustainability.  The Consolidated Framework for Implementation Research (CFIR) is used to identify contextual determinants, which aids in understanding implementation challenges and shaping effective introduction strategies. Intervention Mapping is employed to develop respective implementation strategies. The Interactive Systems Framework (ISF) serves as a background model, ensuring that all relevant system levels are addressed in strategy development.

In the exploration phasis literature reviews are performed to identify determinants for data quality, interventions to improve data quality and strategies to scale-up evidence-based interventions. A contextual analysis is performed for the current quality indicators and the three new quality themes in an ethnographic study to understand current data quality processes, determinants and barriers and facilitators for data quality in LTCFs. The contextual analysis takes place with LTCFs, needs assessment and electronic health record providers and the federal office of statistics and the federal office of public health. Applying Intervention Mapping, implementation strategies will be co-created with stakeholders to support the implementation. Measures and materials supporting the implementation will be prepared.

The phases of a scale-up by Barker et al. are used to implement the intervention.The developed intervention is first tested on a small scale in a pilot study in order to optimize the program before implementation and testing. The program to improve data quality (work-package 1) and support data-driven quality development (work package 2) is then implemented in a national scale-up study. An information package to support facilities in working with the new measurement themes, developed in work package 3, will be implemented. As another part, further new quality indicators for future implementation are investigated based on literature review, Delphi study, and workshop with residents and their relatives.

The sustainment of the implementation is supported by performing an evaluation study. Stakeholder involvement is planned throughout the programme. This is to ensure that the designed implementation package is relevant for practice and has a high likelihood for adoption and sustainability. Frequent engagements are planned with an advisory group coordinated by CURAVIVA and senesuisse, and sounding boards with representatives from LTC facilities and programme partners.